Respir Med [JOURNAL]
Sun
200 papers
One-year trajectories of peripheral and inspiratory muscle strength in critical illness survivors: The impact of ICU-acquired weakness.
Wu MS, Chiu KL, Chiba Y … +5 more , Wei YC, Ruan SY, Hsu KJ, Wang TG, Chen CC
Respir Med · 2026 Aug · PMID 42173293 · Publisher ↗
OBJECTIVE: This prospective cohort study evaluated one-year trajectories of age- and sex-normalized handgrip strength and maximal inspiratory pressure in intensive care unit (ICU) survivors and examined the impact of ICU...
OBJECTIVE: This prospective cohort study evaluated one-year trajectories of age- and sex-normalized handgrip strength and maximal inspiratory pressure in intensive care unit (ICU) survivors and examined the impact of ICU-acquired weakness (ICUAW) on recovery. METHODS: ICU survivors from six medical ICUs in Taiwan were enrolled. ICUAW was identified at ICU discharge using the Medical Research Council sum score (MRC-SS). Peripheral and inspiratory muscle strength were assessed by handgrip strength (HGS) and maximal inspiratory pressure (MIP) at ICU discharge and 1, 3, 6, and 12 months, and expressed as age- and sex-specific normative values. Trajectories were analyzed using Generalized Estimating Equations. RESULTS: 275 ICU survivors completed the MRC-SS assessment at ICU discharge; 166 (60.4%) required mechanical ventilation, and 62 (22.5%) screened positive for ICUAW. In the ICUAW group, mean HGS improved from 30.0% to 56.1% and MIP from 15.4% to 36.5% of normative values over one year. In contrast, non-ICUAW survivors improved from 70.2% to 97.5% for HGS and from 35.4% to 63.1% for MIP. Both groups showed significant improvements in HGS and MIP (p < .001), while ICUAW survivors exhibited lower muscle strength than those without ICUAW (HGS: β = -36.8; MIP: β = -23.1; p < .001). Group-by-time interactions were non-significant, indicating parallel improvements with a persistent deficit in the ICUAW group. CONCLUSIONS: Survivors with ICUAW improved over time but remained consistently below non-ICUAW peers, particularly because of early respiratory weakness. Early screening, reassessment, and targeted peripheral and inspiratory muscle strengthening may help optimize recovery after ICU discharge.
PneumoMLPred: Innovating pneumonia management with guideline adherence review and explainable machine learning-based mortality prediction - A single-centre retrospective study.
Samara KA, Barqawi HJ, Adra S … +11 more , Aldaher B, Kampani DD, Haddad E, Soudan H, Anwar II, Adi MB, Hamadi O, Almour Y, Nassef M, Al Aghbari Z, Abu-Gharbieh E
Respir Med · 2026 Aug · PMID 42162923 · Publisher ↗
INTRODUCTION: Community-acquired pneumonia (CAP) is one of the leading causes of death globally. Changing antibiotic resistance profiles, paucity of reliable CAP mortality prediction models, and ageing populations will i...
INTRODUCTION: Community-acquired pneumonia (CAP) is one of the leading causes of death globally. Changing antibiotic resistance profiles, paucity of reliable CAP mortality prediction models, and ageing populations will increase its burden. This study aims to evaluate adherence to CAP management guidelines as well as develop an ML-based mortality prediction model. METHODS: This retrospective, chart review included all CAP cases between 2016 and 2021. Variables collected included patients' demographics, comorbidities, vitals, laboratory, imaging, and culture findings, as well as initial and targeted antibiotic regimens. Data was pre-processed and analysed in python-3. Adherence to the American thoracic society/infectious diseases society of America 2019 guidelines (ATS/IDSA) was evaluated. The minimum required antibiotic dosages used to determine guideline adherence were defined according to the 2019 ATS/IDSA guidelines for an average adult with normal renal function. Random forest was used for feature selection, while several base classifiers and ensembles were evaluated. SHAP was used to generate interpretable factors for the best-performing model. RESULTS: 783 cases were included, all of which were Pneumonia Severity Index (PSI) class IV/V; overall mortality rate was 15.75%. Etiological diagnosis was rarely established and was not used to guide antibiotic usage. Prescribed doses were frequently below the recommended levels. Less than one-third of cases were adhering to the 2019 ATS/IDSA management guidelines. PneumoMLPred, an explainable support vector classifier-based pneumonia prognostication model, had accuracy = 88.5%, specificity = 96.3%, and AUROC = 0.87. SHAP revealed that PSI, CRP, and kidney diseases were the top three drivers behind in-hospital mortality. CONCLUSIONS: Adherence to the 2019 ATS/IDSA guidelines was very limited. PneumoMLPred has great potential for in-hospital CAP mortality prediction.
Real-world prescribing patterns of inhaled corticosteroid-containing inhalers following acute respiratory tract infections: A nationwide claims database study.
Taniguchi J, Aso S, Yasunaga H
Respir Med · 2026 Aug · PMID 42162922 · Publisher ↗
BACKGROUND: Inhaled corticosteroid (ICS)-containing inhalers are not routinely recommended for acute cough following respiratory tract infections in patients without chronic respiratory diseases; however, they are someti...
BACKGROUND: Inhaled corticosteroid (ICS)-containing inhalers are not routinely recommended for acute cough following respiratory tract infections in patients without chronic respiratory diseases; however, they are sometimes prescribed for acute cough. This study aimed to characterize real-world patterns of inhaled therapy initiation following respiratory tract infections. METHODS: This retrospective descriptive study utilized an administrative claims database in Japan. We identified adult outpatients without chronic respiratory diseases, who were diagnosed with acute upper or lower respiratory tract infections between 2006 and 2022, and enrolled those who received an ICS-containing inhaler within 21 days of the diagnosis. We assessed treatment patterns, diagnostic examinations (imaging, blood tests, and pulmonary function testing), and medication costs. Potentially inappropriate prescription was defined as inhaler initiation without diagnostic examinations from the respiratory tract infection diagnosis to 30 days after initiation, with no re-prescription within 90 days. RESULTS: Among 4,640,282 eligible patients, 267,887 (5.8%) received an ICS-containing inhaler. The median time to initiation was 1 day; most prescriptions were issued on the day of diagnosis. Pulmonary function testing was performed in 16.7% of patients. The proportion of re-prescription within 90 days was 26.0%. Overall, 40.3% met the definition of potentially inappropriate prescription. In these patients, the median cost of ICS-containing inhalers was USD 20.0, representing 59.3% of the total medication expenditure for respiratory tract infections. CONCLUSIONS: ICS-containing inhalers were sometimes prescribed as one-time treatments following respiratory tract infections without objective evaluation, reflecting short-term empirical use rather than maintenance therapy and potentially contributing to inefficient healthcare resource utilization.
Unstable exacerbating COPD: Unaddressed modifiable risk factors or unstable despite optimised care.
Nielsen SB, Mistarz N, Lapperre T … +2 more , Porsbjerg C, Sverrild A
Respir Med · 2026 Aug · PMID 42155782 · Publisher ↗
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major contributors to morbidity, mortality and accelerated lung function decline. While many exacerbations may be driven by modifiable...
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major contributors to morbidity, mortality and accelerated lung function decline. While many exacerbations may be driven by modifiable risk factors, a subset of patients continue to exacerbate despite optimised guideline-based management, potentially identifying a population suitable for advanced therapeutic strategies. OBJECTIVE: To assess the proportion of patients with unstable COPD who experience exacerbations despite optimised care and to identify unaddressed modifiable risk factors. METHODS: This cross-sectional study enrolled patients on double or triple inhaled therapy admitted with AECOPD to Bispebjerg Hospital, Denmark, over 12 months. Six to twelve weeks after discharge, participants underwent a systematic assessment of disease phenotype, treatment barriers, comorbidities, and type 2 inflammation biomarkers. RESULTS: Among 103 patients hospitalised with AECOPD, 34% met criteria for unstable COPD despite optimised care; of these 33% had blood eosinophil counts ≥0.3 × 10 cells/L. Poor adherence (49.5%) and critical errors in inhalation technique (21.4%) were common. One in five patients had at least one undiagnosed or unaddressed comorbidity with the potential to mimic or increase the risk of exacerbations. CONCLUSION: One third of patients with AECOPD had unstable disease despite optimised management. Implementing structured clinical pathways is essential to systematically address modifiable treatment barriers and comorbidities contributing to recurrent exacerbations, and to identify candidates for advanced therapies.
Impact of E-cigarette versus combustible cigarette use on lung function: A cross-sectional study.
Charoenwatanasuksom P, Sae-Lee C, Thaveeratitham P
Respir Med · 2026 Aug · PMID 42150698 · Publisher ↗
INTRODUCTION: Currently, e-cigarettes are often perceived as less harmful than combustible cigarettes, which has contributed to a significant increase in the number of e-cigarette users. Therefore, it is necessary to stu...
INTRODUCTION: Currently, e-cigarettes are often perceived as less harmful than combustible cigarettes, which has contributed to a significant increase in the number of e-cigarette users. Therefore, it is necessary to study the detrimental effects and health consequences associated with e-cigarettes and to ascertain whether e-cigarettes are less dangerous than combustible cigarettes. The present study aims to investigate the impact of e-cigarettes and combustible cigarettes on spirometry, DLCO, and respiratory muscle strength. METHODS: A cross-sectional study was conducted in 123 participants who were divided into three groups: The e-cigarette group, the combustible cigarette group, and the control group. They underwent spirometry, DLCO, and respiratory muscle strength testing. RESULTS: E-cigarette users demonstrated significantly lower FEV1/FVC ratio, FEF25-75%, and MEP compared with controls (p < 0.05). They also showed significantly lower PEF, MIP, and MEP relative to combustible cigarette smokers (p < 0.05). Although DLCO parameters did not differ significantly among groups, e-cigarette users consistently exhibited the lowest mean DLCO values. Additionally, most spirometry, DLCO, and respiratory muscle strength parameters in the e-cigarette group were lower than the normal reference values. CONCLUSIONS: E-cigarette use was associated with reduced pulmonary function, including lower FEV1/FVC ratio, FEF25-75%, PEF, MIP, and MEP. Most pulmonary function parameters in the e-cigarette group showed the lowest mean values and were below normative reference ranges. These findings suggest potential detrimental effects of e-cigarette use on respiratory health more than combustible cigarettes, emphasizing the need for raised awareness about e-cigarettes.
Prevalence of relapse in pulmonary sarcoidosis: A systematic review and meta-analysis.
Hashim Z, Baughman RP, Agarwal R … +6 more , Tripathy NK, Gupta M, Khan A, Kumar A, Kumar A, Nath A
Respir Med · 2026 Jul · PMID 42144146 · Publisher ↗
BACKGROUND AND OBJECTIVE: Relapse after treatment discontinuation or reduction frequently occurs in pulmonary sarcoidosis (PS), but reported rates vary widely. We conducted a systematic review and meta-analysis to estima...
BACKGROUND AND OBJECTIVE: Relapse after treatment discontinuation or reduction frequently occurs in pulmonary sarcoidosis (PS), but reported rates vary widely. We conducted a systematic review and meta-analysis to estimate relapse prevalence and evaluate risk factors. METHODS: We searched PubMed, Embase, Scopus, and Google Scholar from inception through January 2026 for studies reporting relapse prevalence in PS. Two reviewers independently extracted data on relapse prevalence, timing, definitions, and predictors, and assessed study quality using the Hoy et al. tool. We calculated pooled prevalence using random effects models, assessed heterogeneity using I, and performed subgroup analyses and meta-regression. RESULTS: We included 51 studies comprising 6093 patients; 3682 were followed up, and 1442 relapsed. Pooled relapse prevalence was 0.39 (95% CI: 0.33-0.45) with substantial heterogeneity (I = 94%). Relapse prevalence was lower in prospective (0.31, 95% CI: 0.25-0.37) than retrospective (0.45, 95% CI: 0.36-0.54) studies. Only 23 (45%) studies provided explicit relapse definitions, which varied across clinical, radiological, functional, and biomarker criteria. Advanced radiographic stage was associated with higher relapse odds than stage I (log OR 0.55-1.04, corresponding OR 1.73-2.83; p < 0.05), and Black race with higher odds than White race (log OR 0.91, corresponding OR 2.48; p < 0.01). Relapse prevalence did not differ between clinical-only versus composite definitions. CONCLUSIONS: Approximately 39% of PS patients relapse after treatment reduction or discontinuation. Marked heterogeneity in relapse definitions and observational study designs underscores the need for standardized criteria. Clinical assessment appears comparable to complex definitions for assessing relapse. REGISTRATION: PROSPERO CRD420251075384.
Estimation and performance evaluation of Speed-to-MET conversion methods using the 6-Minute Walk Distance.
Szczegielniak J, Bogacz K, Szczegielniak A … +4 more , Wierzbicki M, Łuniewski J, Stanisławski R, Tomaszewski M
Respir Med · 2026 Aug · PMID 42144145 · Publisher ↗
Metabolic Equivalent of Task (MET) is a key measure of exercise intensity and a patient's functional capacity. In clinical practice, MET is typically derived from direct measurements of oxygen consumption (VO) or estimat...
Metabolic Equivalent of Task (MET) is a key measure of exercise intensity and a patient's functional capacity. In clinical practice, MET is typically derived from direct measurements of oxygen consumption (VO) or estimated using formulas based on walking speed. The 6-Minute Walk Distance (6MWD) is one of the most commonly used submaximal tests for assessing functional capacity; however, no rigorously developed model currently allows precise estimation of MET based solely on this test. The aim of this study was to evaluate commonly used formulas and to develop a model enabling estimation of MET from the distance covered during the 6MWD. We analyzed established formulas recommended by the American College of Sports Medicine (ACSM) as well as simplified relationships applied in the 6MWD. Based on empirical VO data, we proposed a regression model that accounts for the nonlinear relationship between walking distance and energy expenditure, combining mathematical optimization with physiological plausibility. Using this approach, we developed a practical conversion table of MET values for distances typical of the 6MWD (100-800 meters). The existing estimation formulas demonstrated limited applicability in clinical populations, particularly at higher distances. In contrast, the proposed nonlinear model captures the distance-MET relationship and enables assignment of MET values based on 6MWD results without the need for treadmill testing or respiratory gas analysis. This tool can support the qualification of patients for rehabilitation and enable more precise planning of individualized training recommendations in clinical settings, contributing to improved clinical decision-making and comparability across studies.
Predicting mortality risk in pediatric severe pneumonia using a CNN-BiLSTM model with dynamic clinical indicators.
Qi W, Ding C, Tu H … +5 more , Yang L, Cao L, Yan C, Chen Z, Sun H
Respir Med · 2026 Jul · PMID 42134457 · Publisher ↗
BACKGROUND: Severe pneumonia is a leading cause of mortality in children under 5 years old, and there is currently a lack of reliable biomarkers for early warning of adverse outcomes in the ICU. This study aimed to explo...
BACKGROUND: Severe pneumonia is a leading cause of mortality in children under 5 years old, and there is currently a lack of reliable biomarkers for early warning of adverse outcomes in the ICU. This study aimed to explore effective prognostic biomarkers for severe pneumonia and apply a deep learning model to predict in-hospital mortality in children with severe pneumonia, thereby supporting clinical decision-making. METHODS: This retrospective prognostic study analyzed clinical data from children under 5 years of age with severe pneumonia from the Pediatric Intensive Care (PIC) database. Patients were categorized according to in-hospital mortality status. Dynamic biomarker screening was performed from longitudinal laboratory data, and a CNN-BiLSTM-based prediction model was subsequently constructed using the selected biomarkers. RESULTS: Eleven key predictive indicators were identified from the laboratory parameters. The CNN-BiLSTM model achieved an area under the curve (AUC) of 0.956 on an independent test set, with a sensitivity of 85.7% and a specificity of 92.7%. Interpretability analysis revealed that lactate, partial pressure of carbon dioxide (pCO), and pH were the most influential predictors. CONCLUSION: This study provides an effective tool for dynamic risk stratification in children with severe pneumonia, offering support for timely clinical decision-making in the ICU. Future multi-center studies are still needed to validate the effectiveness of this model.
Development of a clinical prediction model for discriminative factors of lower respiratory tract infections in patients presenting with fever: A single-center retrospective study.
Jiang B, Wu H, Liu Q … +3 more , Tian R, Zhou M, Li Q
Respir Med · 2026 Jul · PMID 42134456 · Publisher ↗
OBJECTIVE: To identify clinical risk factors for lower respiratory tract infections (LRTIs) in fever outpatients to help differentiate LRTI from upper respiratory tract infections (URTIs). METHODS: This single-center cro...
OBJECTIVE: To identify clinical risk factors for lower respiratory tract infections (LRTIs) in fever outpatients to help differentiate LRTI from upper respiratory tract infections (URTIs). METHODS: This single-center cross-sectional study analyzed data from visitors to the fever clinic to identify risk factors for LRTIs using multivariable LASSO-logistic regression. The model's discriminative performance was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Among 715 patients (173 LRTI, 542 URTI), LRTI patients were older (median 66 vs. 33 years) and more frequently had diabetes (9.2% vs. 2.8%) and hypertension (8.7% vs. 3.3%) (all P < 0.01). Symptoms like cough with sputum (52.0% vs. 40.6%), dyspnea (12.7% vs. 2.8%), diarrhea or vomiting (18.5% vs. 5.0%), appetite loss (6.9% vs. 0.7%), and confusion (5.2% vs. 0.4%) were closely associated with LRTI, while sore throat or nasal congestion was related to upper respiratory tract infections (URTIs) (27.2% vs. 62.7%) (all P < 0.01). LRTI patients had higher white blood cell (WBC) count (9.97 vs. 8.79), neutrophil count (8.22 vs. 6.63) and ratio (81.2% vs. 77.4%), Neutrophil-Lymphocyte Ratio (NLR) value (7.03 vs. 5.37), and C-reactive protein (CRP) level (48.79 vs. 15.26) compared to URTI patients (all P < 0.01). Multivariable logistic regression analysis identified age (OR: 1.043), cough with sputum production (OR: 2.652), diarrhea and vomiting (OR: 2.503), and CRP (OR: 1.009) as independent predictors of fever caused by LRTI (all P < 0.05). The model demonstrated robust performance with an area under curve (AUC) of 0.846, which remained stable upon internal validation (AUC: 0.842). CONCLUSION: Our discriminative model can assist clinicians in using limited outpatient testing indicators to identify fever patients presenting with LRTI, facilitating timely pharmacological interventions. However, prospective external validation is needed before clinical implementation.
Assessment of pulmonary function in preterm infants without bronchopulmonary dysplasia. A pilot observational study.
Gambino M, Ferraro S, Martella D … +6 more , Ghezzi M, Farolfi A, Zambon A, Zuccotti G, D'Auria E, Cavigioli F
Respir Med · 2026 Aug · PMID 42134455 · Publisher ↗
INTRODUCTION: Preterm birth is a major cause of neonatal respiratory morbidity and increases the risk of bronchopulmonary dysplasia (BPD). Tidal-breathing flow-volume loops (TBFVL) enable non-invasive early detection of...
INTRODUCTION: Preterm birth is a major cause of neonatal respiratory morbidity and increases the risk of bronchopulmonary dysplasia (BPD). Tidal-breathing flow-volume loops (TBFVL) enable non-invasive early detection of respiratory abnormalities. While there is extensive data on TBFVL in preterm infants with BPD, data in those without BPD are limited. This prospective cohort study evaluates TBFVL and the impact of prematurity-related variables in preterm infants without BPD. MATERIALS AND METHODS: Subjects were recruited from the Neonatology Unit of Buzzi Children's Hospital in Milan, Italy, from 1st February to 31st December 2025. TBFVLs were performed during natural sleep at term-equivalent postmenstrual age. Time-to-peak expiratory flow to total expiratory time (tPTEF/tE, measuring airway size), respiratory rate, tidal volume/kg and minute ventilation/kg were analysed, comparing them with reference values for term subjects and stratifying the sample by gestational age (GA) (≤32 vs > 32 weeks). Several perinatal variables were collected, to identify potential associations with respiratory outcomes. RESULTS: 38 infants (mean GA 32.76 weeks) were included. The mean tPTEF/tE was significantly lower compared to a previously published cohort of healthy term infants (p < 0.001). Infants born ≤32 weeks had significantly lower values than those born >32 weeks (p < 0.001). Gestational age at birth was the only variable significantly associated with tPTEF/tE. CONCLUSIONS: Preterm infants, even without BPD, show greater signs of airway obstruction at term corrected age. GA at birth emerges as the main determinant of respiratory performance, suggesting a key role for intrauterine lung maturation. Longitudinal studies are needed to define its long-term clinical significance.
ARDSML: A machine learning model for predicting SCAP-associated ARDS based on MIMIC-IV database.
Zhu X, Yuan Z, Shen Q … +4 more , Zhou X, Chen M, Xu X, Yang Y
Respir Med · 2026 Jul · PMID 42128187 · Publisher ↗
BACKGROUND: Early identification of acute respiratory distress syndrome (ARDS) in severe community-acquired pneumonia (SCAP) are crucial for reducing morbidity and mortality. This study focuses on developing an optimal p...
BACKGROUND: Early identification of acute respiratory distress syndrome (ARDS) in severe community-acquired pneumonia (SCAP) are crucial for reducing morbidity and mortality. This study focuses on developing an optimal prediction model based on clinical data and biomarkers to detect the risk of SCAP-associated ARDS in adult ICU patients. METHODS: This investigation, utilizing the MIMIC-IV database, enrolled 3807 patients with SCAP and randomly allocated them into a training set (n = 2664) for model development and a testing set (n = 1143) as an internal validation cohort to assess the model's predictive performance. The outcome was defined as the incidence of SCAP-associated ARDS. Baseline clinical and laboratory characteristics of the patients were obtained. Selection of characteristic variables was performed using LASSO regression, followed by the construction of ten ML models: LGBM, KNN, CatBoost, SVM, XGBoost, DesicionTree, NB, RF, KNNC, and MLP. The evaluation of model performance is conducted through various indicators such as ROC curves, calibration curve, DCA, accuracy, specificity, recall, presicion and F1 score. RESULTS: Initially, 80 characteristic variables were collected, and then 67 of them were selected for the next analysis. After conducting a univariate regression analysis, 32 variables with P < 0.1 were gathered. Through a multicollinearity analysis(VIF≥10), 3 variables were deleted. The remaining 29 variables were subjected to LASSO regression analysis, and 8 of the most significant characteristic variables (Charlson, Lactate, Stroke, Race, AG, ALB, Sepsis, ROX) were selected to build 10 prediction models using machine learning methods. In the training set, the AUROC of the prediction models were respectively LGBM(AUROC = 0.9770), KNN(AUROC = 0.9879), CatBoost(AUROC = 0.9827), SVM(AUROC = 0.8095), XGBoost(AUROC = 0.9999), DesicionTree(AUROC = 0.7611), NB(AUROC = 0.5759), RF(AUROC = 0.8068), KNNC(AUROC = 0.9879), and MLP(AUROC = 0.9661). While in the test set, the AUROC were LGBM(AUROC = 0.9355), KNN(AUROC = 0.6343), CatBoost(AUROC = 0.8745), SVM(AUROC = 0.7912), XGBoost(AUROC = 0.9466), DesicionTree(AUROC = 0.7791), NB(AUROC = 0.5765), RF(AUROC = 0.8074), KNNC(AUROC = 0.6343), and MLP(AUROC = 0.7386). A web calculator utilizing 8 crucial variables to predict SCAP-associated ARDS in adult ICU patients for ARDSML, is now available on our website (https://zxhzxh2000.shinyapps.io/ards/). CONCLUSION: The prediction model constructed based on 8 characteristic variables selected by LASSO regression and using the XGBoost algorithm has excellent predictive performance in predicting the occurrence of SCAP-associated ARDS in adult ICU patients. This data-driven predictive model will help clinicians to make quick and accurate diagnosis.
Aspergillosis complicating idiopathic lung fibrosis: a multicentric series.
Bermudez J, Debray MP, Uzunhan Y … +10 more , Marchand-Adam S, Nunes H, Godet C, Maitre T, Claustre J, Milesi J, Nasser M, Cottin V, Reynaud-Gaubert M, Crestani B
Respir Med · 2026 Jul · PMID 42128186 · Publisher ↗
INTRODUCTION: Fibrotic interstitial lung diseases (ILD) are associated with significant morbidity and poor prognosis. Infections, including chronic pulmonary aspergillosis (CPA), may further worsen outcomes but remain un...
INTRODUCTION: Fibrotic interstitial lung diseases (ILD) are associated with significant morbidity and poor prognosis. Infections, including chronic pulmonary aspergillosis (CPA), may further worsen outcomes but remain understudied in this population. This study aimed to characterize the clinical features and outcomes of ILD patients who develop CPA. METHODS: We conducted a nationwide retrospective study across expert centers of the French rare pulmonary diseases Orphalung network, including patients with idiopathic ILD who met diagnostic criteria for CPA. RESULTS: Twenty-six patients were identified, predominantly male (96%) and smokers (88%). The most common underlying diagnosis was idiopathic pulmonary fibrosis. At CPA diagnosis, median forced vital capacity was 63% [49-87] predicted and DLCO 29% [21-39] predicted. The median interval between ILD diagnosis and CPA onset was 39 months [0-72]. All patients had CT scans showing CPA-compatible features, and 96% tested positive for Aspergillus IgG. Chest computed tomography revealed emphysema in 92% of patients, with CPA lesions predominantly in emphysematous areas (73%) and upper zones (69%). Over a median follow-up of 21 months [10-33], median survival from CPA diagnosis was 24 months [15-NA]. Neither prior corticosteroid nor antifungal treatment was associated with improved survival. DISCUSSION: CPA is a rare but clinically significant complication in patients with fibrotic ILD. Lesions are frequently localized in emphysematous regions, and serum IgG testing is a key diagnostic tool. Further research is needed to better characterize this patient population and optimize management strategies.
Malnutrition in childhood interstitial lung diseases is associated with reduced lung function and greater disease severity: insights from the chILD-EU registry.
Ramasli Gursoy T, Emiralioglu N, Griese M … +19 more , Seidl E, Rodler J, Schwerk N, Carlens J, Wetzke M, Nathan N, Cunningham S, Lange J, Krenke K, Stehling F, Hämmerling S, Proesmans M, Ullmann N, Buchvald F, Galdo AM, Aslan AT, Cobanoglu N, Kiper N, chILD-EU Register and chILD-EU CRC collaborators
Respir Med · 2026 Jul · PMID 42119927 · Publisher ↗
BACKGROUND: Malnutrition is a recognized but insufficiently investigated concern in children with childhood interstitial lung diseases (chILD). The relationship between nutritional status and pulmonary function in this p...
BACKGROUND: Malnutrition is a recognized but insufficiently investigated concern in children with childhood interstitial lung diseases (chILD). The relationship between nutritional status and pulmonary function in this population remains poorly understood. This study aimed to evaluate the frequency and impact of malnutrition in chILD and to identify associated clinical factors. METHODS: We analyzed baseline and follow-up data from the chILD-EU registry, including anthropometric measurements, disease severity scores, pulmonary function tests, and treatment information. Malnutrition was defined as a weight-for-age (WFA) z-score < -2. Multivariable linear regression models were used to assess the association between malnutrition and lung function after adjustment for potential confounders. Longitudinal mixed-effects models were applied to evaluate the relationship between time-varying nutritional status and lung function over time. RESULTS: A total of 3351 visits from 766 children were analyzed. At baseline, 38.9% of children were malnourished. Children with malnutrition had significantly lower lung function compared with those without malnutrition (both p < 0.001). In multivariable analyses adjusting for age, sex, prematurity, diagnostic category, and disease severity, malnutrition remained independently associated with reduced lung function (zFEV β = -0.83, p = 0.007; zFVC β = -1.35, p < 0.001). In longitudinal mixed-effects models including baseline and follow-up visits, improvements in WFA z-scores were associated with improved lung function over time (zFEV β = 0.33, p < 0.001; zFVC β = 0.37, p < 0.001). CONCLUSION: Malnutrition is common among children with chILD and is independently associated with impaired lung function and greater disease severity. Improvements in nutritional status are associated with improved pulmonary outcomes during follow-up, highlighting the importance of routine nutritional monitoring and multidisciplinary care.
Exploring the bone-vascular axis: AI-augmented chest CT analysis in COPD highlights association between vertebral bone density and arterial calcifications.
Palm V, Wagner A, Havlicek O … +10 more , Sedaghat S, Nauck S, von Stackelberg O, Jobst B, Trudzinski FC, Kahnert K, Biederer J, Kauczor HU, Budai BK, COSYCONET study group
Respir Med · 2026 Jul · PMID 42119926 · Publisher ↗
OBJECTIVES: Artificial intelligence (AI) tools enable automated assessment of vertebral bone mineral density (BMD), coronary artery calcification (CAC), and aortic calcification on CT scans, offering multimorbidity analy...
OBJECTIVES: Artificial intelligence (AI) tools enable automated assessment of vertebral bone mineral density (BMD), coronary artery calcification (CAC), and aortic calcification on CT scans, offering multimorbidity analysis in chronic obstructive pulmonary disease (COPD) patients. We aimed to investigate the bone-vascular axis with a focus on COPD severity and inhaled corticosteroid (ICS) use. METHODS: Low-dose chest CTs of 540 patients from the COSYCONET study were analyzed using AI-based tools. Total thoracic calcification (TTC) was defined as the sum of CAC and aortic calcification volumes. The BMD was measured for T12 in Hounsfield units. Group comparisons and correlation analyses were stratified by COPD severity (GOLD 0-2 vs. GOLD 3-4) and ICS treatment. The modification effect was assessed with multivariable and interaction models. RESULTS: Higher CAC and TTC were significantly associated with increased age, smoking, BMI, and impaired physical function, while gait speed, female sex, and BMD were inversely associated. With no significant difference between GOLD stages, BMD showed a consistent negative correlation with both CAC (ρ = -0.247 and -0.243) and TTC (ρ = -0.286 and -0.304). Interaction analyses revealed no significant modification effect for COPD severity; a marginally significant trend toward a stronger association among ICS users for CAC (β = -0.175, p = 0.042), but no significant effect for TTC. CONCLUSION: The decreased vertebral BMD was associated with increased vascular calcification, independent of COPD severity and marginally dependent on ICS therapy. These findings support the concept of "bone-vascular axis", likely driven by shared degenerative mechanisms.
MIST versus INSURE: Superior outcomes in surfactant administration for preterm neonates with RDS.
Boskabadi H, Afzaljavan F, Zakerihamidi M
Respir Med · 2026 Jul · PMID 42114726 · Publisher ↗
INTRODUCTION: Minimally invasive surfactant therapy (MIST) is increasingly adopted in neonatal care as an alternative to the INSURE (Intubation-Surfactant-Extubation) method for managing respiratory distress syndrome (RD...
INTRODUCTION: Minimally invasive surfactant therapy (MIST) is increasingly adopted in neonatal care as an alternative to the INSURE (Intubation-Surfactant-Extubation) method for managing respiratory distress syndrome (RDS) in preterm infants. MIST reduces intubation-related complications and facilitates surfactant administration without invasive ventilation. This study aimed to compare the complications and outcomes of surfactant delivery via MIST versus INSURE in preterm infants with RDS. METHODS: In this retrospective study, we analyzed data from 513 preterm infants (gestational age: 28-34 weeks) with RDS admitted to Ghaem Hospital, Mashhad, Iran, between 2019 and 2025. Outcomes were compared between 257 infants treated with INSURE and 256 treated with MIST. Data on gestational age, birth weight, Apgar scores (1st and 5th minute), need for mechanical ventilation, duration of oxygen therapy, and surfactant re-dosing were collected using a structured checklist. Statistical analysis was performed using SPSS v26. RESULTS: Mean gestational age was 30.9 ± 2.6 weeks. Short-term outcomes revealed no statistically significant difference in mortality between the two methods. However, the MIST group demonstrated significantly lower rates of short-term complications, including reduced duration of mechanical ventilation (P = 0.0001), retinopathy of prematurity (ROP; P = 0.026), and sepsis (P = 0.010). CONCLUSION: MIST is a safe and effective alternative to INSURE for surfactant administration in preterm infants with RDS. It is associated with improved short-term outcomes, including shorter mechanical ventilation duration and lower incidences of ROP and sepsis. These findings support MIST as a preferable approach in clinical practice.
Outcome measures for dysfunctional breathing: A scoping review of use, validation, and research gap.
Stacey A, Sanchez-Bracero D
Respir Med · 2026 Jul · PMID 42114725 · Publisher ↗
INTRODUCTION: Dysfunctional Breathing (DB) is a complex, multifactorial condition affecting respiratory function and quality of life. Its definition remains inconsistent, creating challenges in diagnosis and clinical man...
INTRODUCTION: Dysfunctional Breathing (DB) is a complex, multifactorial condition affecting respiratory function and quality of life. Its definition remains inconsistent, creating challenges in diagnosis and clinical management. The tools used to assess and monitor DB are heterogeneous, often lack validation, and are applied inconsistently, limiting comparability between studies and clinical decision-making. AIMS: This scoping review aims to systematically map the outcome measures used to assess dysfunctional breathing and identify gaps in their application and validation. METHODS: A comprehensive search including both peer-reviewed and grey literature was conducted across relevant databases. Screening and data extraction followed Joanna Briggs Institute (JBI) guidelines. RESULTS: Of 239 records identified, 69 studies met inclusion criteria. Twenty-two distinct outcome measures (OMs) were reported, assessing biomechanical (n = 10), biochemical (n = 6), and psychophysiological (n = 4) features of DB and two evaluated more than one dimension. The Nijmegen Questionnaire (NQ) was the most frequently used OM (n = 41). Only 12 studies formally evaluated psychometric properties of the OMs. Populations ranged from paediatric to adult, with fifty-six studies employing multiple OMs rather than a single tool. CONCLUSION: Outcome measures used to assess dysfunctional breathing are highly heterogeneous, poorly standardised, and rarely fully validated, particularly in populations with comorbidities. No single tool captures all dimensions of the condition, and reliance on multiple measures highlights uncertainty in its definition and assessment rather than true diagnostic precision. Establishing a standardised suite of validated outcome measures, aligned with clearly defined domains of DB, is essential to improve assessment accuracy, clinical utility, and research comparability.
The economic evaluation of chronic obstructive pulmonary disease care: Quality and cost - a web of science-based systematic review.
Yıldırım K, Çoban M, Bilge U … +4 more , Özler SŞ, Aygül HH, İçöz ZG, Bozkurt N
Respir Med · 2026 Jul · PMID 42114724 · Publisher ↗
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) results in significant healthcare costs for treatment and follow-up. The aim of the study is to examine direct and indirect expenditures in studies conducting econ...
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) results in significant healthcare costs for treatment and follow-up. The aim of the study is to examine direct and indirect expenditures in studies conducting economic evaluations for COPD. METHODS: Several scales are used to evaluate the studies. One of the most recognised checklists "The Consensus on Health Economic Criteria" (CHEC)-list designed by Evers et al., in 2005 aims to answer two important questions: is the methodology of the study appropriate, and are the results of the study valid? Studies focusing on COPD and its economic costs were reviewed in this study. The evaluation of direct and indirect costs was reviewed. It was evaluated whether indirect costs borne by patients and their families were considered. RESULTS: A total of 69 articles retrieved from Web of Science between 1970 and 2021 were examined. It is seen that the studies generally received high scores in terms of purpose and research question, but some studies received low scores in terms of indirect costs, ethical dimension, application of sensitivity analysis and study design. In approximately half (50.7%) of the studies, sensitivity analysis was performed, and ethical concerns were addressed in 50.7% of the studies. CONCLUSION: Medical costs were considered in COPD but indirect costs borne by patients and/or their relatives were not. Their main recommendations consider social care costs as well as medical costs. Results of our study can guide policy-making and planning for managing COPD burden.
Dyspnea and fatigue in Long-COVID: definition of risk factors and of DLCO-based phenotypes in a multicenter study of 765 patients from Italy.
Floridia M, Weimer LE, Lo Forte A … +11 more , Palange P, Agostoni P, Ciardi MR, Tosato M, Lacedonia D, Gnerre P, Barisione E, Martino GP, Vagheggini G, Onder G, ISS Long-COVID Study Group
Respir Med · 2026 Jul · PMID 42107843 · Publisher ↗
BACKGROUND: Dyspnea and fatigue represent common Long-COVID symptoms, but their presence is not always accompanied by lung function abnormalities. Aim of the study was to evaluate dyspnea and fatigue in relation to pulmo...
BACKGROUND: Dyspnea and fatigue represent common Long-COVID symptoms, but their presence is not always accompanied by lung function abnormalities. Aim of the study was to evaluate dyspnea and fatigue in relation to pulmonary function and exercise capacity. METHODS: Multicenter cohort study. Multivariable analyses were used to characterize, for both symptoms, functional phenotypes with and without pulmonary impairment according to the diffusing lung capacity for carbon monoxide (DLCO). Exercise capacity was assessed through the distance walked in 6 min (6MWD). RESULTS: Among 765 patients evaluated at a mean interval of six months from COVID-19, rates of dyspnea and fatigue were 41.3% and 41.6%, respectively. Roughly half of the patients with these two symptoms (51.6% and 54.7%, respectively) had normal pulmonary function at DLCO testing (≥80% of predicted). Low-DLCO (<80%) dyspnea was significantly associated with female sex, anxiety, duration of hospitalisation, use of corticosteroids and of monoclonal neutralizing antibodies, and its risk decreased at the increasing in time from acute infection. Normal-DLCO dyspnea was associated with younger age and obesity. Low-DLCO fatigue was associated with female sex, heart failure, anxiety and use of corticosteroids. Normal-DLCO fatigue was not associated with demographics, comorbidities, or COVID-19 severity. For both symptoms, the low-DLCO phenotypes had a significantly lower 6MWD. CONCLUSIONS: The clinical phenotypes of dyspnea and fatigue with normal pulmonary function should be further explored, possibly with additional tests that assess cardiorespiratory and cardiovascular function. DLCO testing should be included in the evaluation of patients who report dyspnea and/or fatigue as possible Long-COVID symptoms.
Corrigendum to "Risk of influenza-related hospitalization and mortality in autoimmune inflammatory rheumatic diseases (AIIRD): Insights on polymyositis/dermatomyositis, Sjögren's disease, and systemic sclerosis" [Respiratory Medicine 257 (2026) 108840].
Chang YS, Lin YC, Chien YN … +5 more , Su CF, Kao JH, Lin SH, Lai CC, Lee IP
Respir Med · 2026 Jul · PMID 42106197 · Publisher ↗
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Prognostic value of TAPSE/sPAP in pulmonary arterial hypertension: a systematic review and meta-analysis.
Luo Q, Li S, Huang Z … +5 more , Ran Y, Zhao Q, Deng L, Zhao Z, Liu Z
Respir Med · 2026 Jul · PMID 42106158 · Publisher ↗
OBJECTIVES: Tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) is a simple and validated right ventricle-pulmonary artery (RV-PA) coupling parameter in pulmonary arterial...
OBJECTIVES: Tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP) is a simple and validated right ventricle-pulmonary artery (RV-PA) coupling parameter in pulmonary arterial hypertension (PAH). Its prognostic significance for clinical outcomes, however, remains uncertain. This study aimed to evaluate the association between TAPSE/sPAP and key clinical outcomes in PAH. METHODS: Medline, Embase, and Cochrane Library were searched from inception to 4 March 2025. Cohort studies evaluating associations between TAPSE/sPAP and clinical outcomes in PAH patients were included. Primary outcome was the composite endpoints of all-cause mortality, lung transplantation after re-evaluation, or clinical worsening. Secondary outcomes included individual components of the primary endpoint, time to clinical worsening (TTCW), and ratio of end-systolic elastance to arterial elastance (Ees/Ea). Hazard ratios (HR) with 95% confidence intervals (CIs) were pooled using a fixed-effect model. RESULTS: Fourteen studies were included. Higher baseline TAPSE/sPAP was significantly associated with a lower risk of composite endpoints (dichotomous HR = 0.49; continuous HR = 0.93), reduced all-cause mortality (dichotomous HR = 0.49; continuous HR = 0.94) and lower risk of clinical worsening (dichotomous HR = 0.36; continuous HR = 0.00). Follow-up TAPSE/sPAP was also inversely associated with the composite outcome (dichotomous HR = 0.43). No consistent association was observed between TAPSE/sPAP and Ees/Ea. CONCLUSION: TAPSE/sPAP is a strong prognostic marker in PAH, significantly associated with lower risk of composite endpoints, all-cause mortality, and clinical worsening. Follow-up TAPSE/sPAP also predicts outcomes, though its evidence for mortality and worsening remains limited and requires further study.
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