Respir Med [JOURNAL]
Sun
200 papers
Ventilatory ratio as a predictor of mortality in acute respiratory distress syndrome: a systematic review and Bayesian meta-analysis of observational studies.
Parada-Gereda HM, Peña-López LA, Muñoz-Escudero DF … +5 more , Molano-Franco D, Parrilla-Gómez FJ, Grillo CF, Rodriguez IJ, Masclans JR
Respir Med · 2026 Jul · PMID 42103172 · Publisher ↗
BACKGROUND: The ventilatory ratio (VR) has been proposed as a simple and accessible index to estimate ventilatory inefficiency and physiological dead space in critically ill patients with acute respiratory distress syndr...
BACKGROUND: The ventilatory ratio (VR) has been proposed as a simple and accessible index to estimate ventilatory inefficiency and physiological dead space in critically ill patients with acute respiratory distress syndrome (ARDS). However, its association with mortality remains controversial, partly due to the methodological heterogeneity of the published studies. METHODS: A systematic review and Bayesian random-effects meta-analysis were conducted to assess the association between VR and mortality in patients with ARDS. Observational studies reporting crude or adjusted odds ratios (OR) that analysed the association between VR and mortality were included. The search was performed in PubMed, Embase, Scopus, Cochrane, and LILACS databases up to April 2025. Bayesian model, subgroup analyses, meta-regression, and sensitivity analyses were applied. Publication bias was assessed using a funnel plot and Egger's test. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool, and the certainty of evidence was assessed using the GRADE approach. The protocol was registered in PROSPERO (CRD42024538654). RESULTS: A total of 23 studies were identified, of which 17 were included in the systematic review and meta-analysis of observational studies. The pooled OR for the association between VR and mortality was 1.55 (95% credible interval: 1.27-1.96), with moderate-to-high heterogeneity (τ = 0.41, I = 71.9%). Sensitivity and meta-regression analyses confirmed the robustness of the findings across different model specifications and study characteristics. Risk of bias was rated as moderate in 3 studies and low in 20, according to the QUIPS tool, and the overall certainty of the evidence was rated as low using the GRADE approach. CONCLUSIONS: Higher VR values were associated with increased mortality risk in patients with ARDS. However, moderate-to-high heterogeneity across studies indicates that these findings should be interpreted cautiously. VR may represent a complementary prognostic marker, but prospective studies are needed to validate its performance and determine its incremental value over established indices such as PaO/FiO.
Beyond the lungs: The role of extrapulmonary manifestations in the quality of life of Indians with chronic airway diseases.
Bhadra R, Sambashivaiah S, D'Souza G … +2 more , Selvam S, Schols AMWJ
Respir Med · 2026 Jul · PMID 42103171 · Publisher ↗
PURPOSE: Chronic airway diseases (CAD) including chronic obstructive pulmonary disease (COPD), persistent asthma (≥2weekly episodes) and bronchiectasis, exhibit overlapping extrapulmonary manifestations potentially affec...
PURPOSE: Chronic airway diseases (CAD) including chronic obstructive pulmonary disease (COPD), persistent asthma (≥2weekly episodes) and bronchiectasis, exhibit overlapping extrapulmonary manifestations potentially affecting health-related quality-of-life (HRQOL). The study objective was to quantify HRQOL of CAD patients and identify impact of associated pulmonary and extrapulmonary manifestations. METHODOLOGY: Total 101 established CAD patients were recruited cross-sectionally (COPD, n = 61, persistent asthma, n = 30 and bronchiectasis, n = 10). Patients completed spirometry, body composition (Dual-energy X-ray Absorptiometry), muscle function (isometric and isokinetic dynamometry), exercise capacity (6-min walking distance, 6MWD) and patient reported outcomes, including physical activity, sleep and hospital anxiety and depression scale. HRQOL was assessed using EuroQol quality-of-life questionnaire and utility score (EQ-5D index) was stratified into tertiles to compare patient characteristics. RESULT: Mean age of participants was 60.9 ± 12.8y, and 25.7% were female. Mean EQ-5D index was 0.658 (95%CI: 0.596, 0.721), significantly lower than population norms and other chronic diseases including diabetes, cardiovascular diseases and rheumatoid heart disease (p < 0.01). Participants in lowest EQ-5D tertile were older, had higher depression, lower 6MWD, lower handgrip and quadriceps muscle strength than other two tertiles, whereas anxiety was higher in both lowest and intermediate tertile compared to highest tertile (p < 0.01). In the adjusted regression model, age (AOR:1.187) depression (AOR:1.438), anxiety (AOR:1.266), and body fat (AOR:1.114) showed increased odds for poor EQ-5D index while in intermediate vs highest EQ-5D tertile, only age (AOR: 1.125) and anxiety (AOR:1.403) showed a significant association. CONCLUSION: HRQOL is significantly lower in CAD compared to other chronic non-communicable diseases and significantly associated with extrapulmonary manifestations. Interventions targeting modifiable risk factors may aid in improving HRQOL in CAD.
Development and validation of a nomogram prediction model for prolonged length of hospital stay in patients with AECOPD.
Tang S, Li J, Peng J … +3 more , Xu X, Wang H, Chen L
Respir Med · 2026 Jul · PMID 42103170 · Publisher ↗
OBJECTIVE: This study aimed to investigate risk factors of prolonged length of hospital stay (LOHS) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to develop a predictive nomog...
OBJECTIVE: This study aimed to investigate risk factors of prolonged length of hospital stay (LOHS) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to develop a predictive nomogram. APPROACH: AECOPD patients admitted to the Department of Respiratory and Critical Care Medicine at West China Hospital between January 2010 and December 2019 were retrospectively analyzed and randomly divided into training and validation sets (7:3). Least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analyses were performed to screen independent predictors, which were incorporated into a nomogram. Model performance was evaluated through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS: A total of 3146 patients were included, with 2202 in training set and 944 in validation set. Twelve variables were independently associated with prolonged LOHS and incorporated into the nomogram, including onset seasons, hemoglobin (Hb), white blood cells (WBC), albumin (ALB), sputum cultures, respiratory failure and respiratory support modes, use of anticoagulants, antibiotics and systemic glucocorticoids, heart failure, and malignant tumors. The area under the ROC curve (AUC) was 0.760 (95% CI: 0.737-0.783) in training set and 0.746 (95% CI: 0.710-0.783) in validation set, demonstrating strong discrimination. Calibration curves closely aligned with the diagonal, indicating high consistency between predicted and observed values. DCA showed substantial net benefits, highlighting the model's clinical utility. CONCLUSIONS: A nomogram prediction model was developed and validated, facilitating early identification of AECOPD patients at risk for extended LOHS and supporting informed clinical decision-making and optimal resource allocation.
The effect of inhaler prescription and comorbidities on the prognosis of COPD in never-smokers: A nationwide population-based study.
Sheen SS, Oh JH, Choi WI … +3 more , Kim K, Rhee CK, Park JH
Respir Med · 2026 Jul · PMID 42103169 · Publisher ↗
BACKGROUND: Most clinical trials evaluating inhaler therapy in COPD have been conducted predominantly in smoking populations, and prognostic factors and therapeutic outcomes in COPD without any history of smoking were no...
BACKGROUND: Most clinical trials evaluating inhaler therapy in COPD have been conducted predominantly in smoking populations, and prognostic factors and therapeutic outcomes in COPD without any history of smoking were not well investigated. Therefore, this study was conducted to investigate the effect of inhaler prescription and comorbidities on the prognosis of COPD in never-smokers. METHODS: A retrospective observational study was undertaken using data from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) Survival analyses were performed according to inhaler prescriptions and comorbidities from index date to December 31, 2019. RESULTS: Among 2432 eligible patients, 382 (15.7%) received long-acting muscarinic antagonist(LAMA)/long-acting β-agonist(LABA) therapy, 1780 (73.2%) received inhaled corticosteroid(ICS)/LABA, 187 (7.7%) received LAMA monotherapy, and 83 (3.4%) received LABA monotherapy. In multivariate Cox regression analysis, compared with the LAMA/LABA group, the ICS/LABA group had significantly higher all-cause (HR 1.65; 95% CI 1.22-2.24) and respiratory mortality (HR 1.72; 95% CI 1.07-2.77). Coexisting heart failure, frequent hospitalizations (≥2 times/year vs. none), and emergency room visits along with older age, male sex, and lower body mass index (BMI) were also independently associated with higher respiratory and all-cause mortality (p < 0.05). CONCLUSION: Our data in the cohort of non-smoking COPD suggest that LAMA/LABA therapy was associated with better survival rate compared with ICS/LABA therapy. Moreover, comorbid heart failure, frequent hospitalizations, emergency room visits, older age, male sex, and lower BMI were also independently linked to higher risks of respiratory and all-cause mortality.
Network-based analysis of images and lesions expressed by digital interpretation and transmission of bronchoscopy findings on social media (NAILED-IT).
Gilbert CR, Yarmus LB, Kapp C … +6 more , Argento AC, Akulian JA, Gorden JA, Thiboutot J, Silvestri GA, Maldonado F
Respir Med · 2026 Jul · PMID 42103168 · Publisher ↗
INTRODUCTION: Diagnostic bronchoscopy has advanced rapidly over the last two decades with the adoption of novel technologies. Concurrently, social media platforms have proliferated, with some pulmonologists sharing and p...
INTRODUCTION: Diagnostic bronchoscopy has advanced rapidly over the last two decades with the adoption of novel technologies. Concurrently, social media platforms have proliferated, with some pulmonologists sharing and promoting these new technologies and diagnostic successes. The impact of this content on perceptions of diagnostic yield and utility remains unclear. METHODS: A scoring system was developed to evaluate social media posts related to bronchoscopy. The BIASED score ranges from 1 to 6 points, awarding one point each for the inclusion of: Brand/technology mention, Imaging (diagnostic), Anatomy description, Successful diagnosis, Educational value, and Data on the procedure. Nine participants reviewed and scored bronchoscopy-related posts across multiple social media platforms. Descriptive statistics were used to summarize findings. RESULTS: Social media platforms were reviewed that included Facebook, Instagram, LinkedIn, TikTok, and YouTube. Diagnostic bronchoscopy related posts were identified and scored after visual filtering for the presence of radiographic or bronchoscopic imaging. The mean BIASED score was 4.59. Most posts emphasized positive diagnostic outcomes, with only two social media accounts posting content related to non-diagnostic bronchoscopy results. DISCUSSION: This study represents one of the first attempts at descriptive assessment of bronchoscopy-related content on social media. Many posts demonstrated high BIASED scores, which appear to emphasize favorable outcomes with diagnostic bronchoscopy. The BIASED scoring system provides a feasible method to quantify characteristics of bronchoscopy-related social media content and may serve as a framework for future analyses.
Widening racial/ethnic disparities in hospitalizations for asthma with type II diabetes: A trend analysis (1998-2021).
Kim Y, Kim I, Yoo JW … +4 more , Chung TH, Brown L, Kwak I, Moonie S
Respir Med · 2026 Jul · PMID 42097371 · Publisher ↗
BACKGROUND: Recent literature has reported an association between diabetes and asthma, along with their contribution to increased disease burden. However, there is still limited knowledge on trends in diabetes-related as...
BACKGROUND: Recent literature has reported an association between diabetes and asthma, along with their contribution to increased disease burden. However, there is still limited knowledge on trends in diabetes-related asthma. OBJECTIVE: We aimed to examine the trend in hospitalizations for diabetes-related asthma by race/ethnicity and determine whether racial/ethnic disparities in hospitalizations widened over time. METHODS: We employed a retrospective, ecological, and longitudinal study design. Using the US National Inpatient Sample data, we selected 4,180,038 patient records for asthma and 518,983 records for diabetes-related asthma (1998-2021). Applying linear regression and ARIMA, we assessed race/ethnicity-specific monthly trends in hospitalization rates for diabetes-related asthma (n = 288) and examined the differences in hospitalization rates between marginalized racial/ethnic groups and their White counterparts. RESULTS: African American patients (21.54%: β = 0.51, p < 0.01) showed the highest growth rate in hospitalization rate for diabetes-related asthma, followed by Asian (2.10%; β = 0.50, p < 0.01) and Hispanic (12.14%; β = 0.42, p < 0.01) patients. No significant increase was found among White patients. The increase in racial/ethnic difference in hospitalization rates for diabetes-related asthma was greater among African American-White (β = 0.25, p < 0.0001) and Asian-White (β = 0.25, p < 0.001) patients than Hispanic-White patients (β = 0.19, p < 0.01), indicating a rapid increase among those racial/ethnic groups. CONCLUSION: The findings indicate a significant increase in hospitalization rates for diabetes-related asthma among marginalized racial/ethnic groups. Particularly, African American and Asian patients revealed a more rapid increase in hospitalization rate than Hispanic patients. Targeted, integrated interventions for the high-risk populations are necessary for managing diabetes, which may improve asthma control and contribute to the effective management of asthma.
Association of coronary calcification or vascular inflammation and cardiovascular events and prognosis in non-small cell lung cancer: A retrospective study.
Hayashi M, Fujimoto K, Endo J … +4 more , Matsumoto-Miyazaki J, Kanamori H, Matsuo M, Okura H
Respir Med · 2026 Jul · PMID 42092596 · Publisher ↗
BACKGROUND: Coronary artery disease and lung cancer share common risk factors, which may increase the risk of cardiovascular events in patients with lung cancer. Coronary artery calcification (CAC) and vascular inflammat...
BACKGROUND: Coronary artery disease and lung cancer share common risk factors, which may increase the risk of cardiovascular events in patients with lung cancer. Coronary artery calcification (CAC) and vascular inflammation can be evaluated through chest computed tomography (CT) and 18F-FDG-PET/CT, respectively. This study aimed to evaluate the relationship between CAC or vascular inflammation and cardiovascular events in patients with non-small cell lung cancer (NSCLC). METHODS AND RESULTS: We studied 119 patients with NSCLC who underwent both chest CT and 18F-FDG-PET/CT. CAC score was measured using chest CT. Vascular inflammation was assessed using 18F-FDG-PET/CT, with the maximum target-to-background ratio (TBR) measured at 8 major arteries. Cardiovascular events, including all-cause death, acute coronary syndrome, unplanned coronary revascularization for angina pectoris, and stroke, were compared between groups with high and low TBR and high (≥100) and low (<100) CAC scores. Cardiovascular event-free survival tended to be lower in high CAC score than low CAC score group (Log rank, P = 0.105). Among patients with early-stage lung cancer (stage 0-II), cardiovascular event-free survival was similar between the two groups. However, in patients with advanced lung cancer (stage III or IV), cardiovascular event-free survival was significantly lower in high CAC score than low CAC score group (Log rank, P = 0.029). On the other hand, there were no significant differences in cardiovascular event-free survival between high and low TBR groups. CONCLUSION: Coronary artery calcification may be associated with cardiovascular events and mortality in patients with advanced-stage NSCLC, whereas vascular inflammation was not associated with outcomes in this cohort.
Validation and minimum important difference of the chronic respiratory disease questionnaire in patients with interstitial lung disease.
Chi E, Holland AE, Hill CJ … +4 more , Goh NS, Glaspole I, McDonald CF, Dowman L
Respir Med · 2026 Jul · PMID 42067073 · Publisher ↗
BACKGROUND: The Chronic Respiratory Disease Questionnaire (CRQ) was developed to measure health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), with a minimum clinically imp...
BACKGROUND: The Chronic Respiratory Disease Questionnaire (CRQ) was developed to measure health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), with a minimum clinically important difference (MCID) of 0.5 points per item. It has been used in clinical trials of patients with interstitial lung disease (ILD), however its validity and MCID in this population is unknown. QUESTION: Is the CRQ a valid measure of HRQoL in people with ILD and what is the MCID in this population? STUDY DESIGN AND METHODS: Data from a multicentre randomised controlled trial of pulmonary rehabilitation (PR) in 142 patients with ILD were analysed. Concurrent validity with the St George's Respiratory Questionnaire for IPF (SGRQ-I), known groups validity between patients of varying TLCO and GAP Index, and responsiveness to change after PR were assessed. MCID was calculated using anchor- and distribution-based methods. Analyses were repeated for the idiopathic pulmonary fibrosis (IPF) subgroup. RESULTS: There was a strong association between CRQ and SGRQ-I scores (r = -0.786, p < 0.05). CRQ scores differed significantly between patients in the highest and lowest TLCO quartile (effect sizes -0.49 to -0.64) and between GAP Index groups (p < 0.05), except for the emotional function domain. The CRQ was responsive to PR (effect size -0.53). The MCID ranged from 0.45 to 0.65 points per item. Results were similar in the IPF subgroup. INTERPRETATION: The CRQ is a valid and responsive measure of HRQoL in patients with ILD, including those with IPF, with an MCID of around 0.5 points per item. These findings support the use of the CRQ in ILD.
Inhalers and climate change: A sustainable approach to severe asthma management.
Villamañán E, Laorden D, Carpio C … +5 more , De Las Vecillas L, Domínguez-Ortega J, Quirce S, Álvarez-Sala R, ASMAGRAVE-HULP group
Respir Med · 2026 Jul · PMID 42067072 · Publisher ↗
BACKGROUND: The healthcare sector significantly contributes to greenhouse gas emissions, with pharmaceuticals accounting for 20-35% of the total. Among these, pressurised metered-dose inhalers (pMDIs), commonly used in a...
BACKGROUND: The healthcare sector significantly contributes to greenhouse gas emissions, with pharmaceuticals accounting for 20-35% of the total. Among these, pressurised metered-dose inhalers (pMDIs), commonly used in asthma management, contain hydrofluorocarbon (HFC) propellants with high global warming potential (GWP), representing the medications with the highest carbon footprint. OBJECTIVE: To assess the extent of pMDI use among patients with severe asthma (SA) and to evaluate the feasibility of replacing them with more environmentally sustainable alternatives without affecting treatment adherence or disease control. METHODS: This observational, descriptive study was conducted in a multidisciplinary severe asthma clinic at a tertiary hospital in Spain. Adult patients with SA managed in 2024 were included. Variables analysed included inhaler prescriptions, treatment adherence based on the medication possession ratio (MPR), and the estimated CO emissions associated with each inhaler type. RESULTS: Among 223 SA patients (mean age: 61.4 years; 70.4% female), 43.4% were prescribed pMDIs. Triple therapy (LABA-ICS-LAMA) in a single device was predominantly delivered via pMDIs (66.7%). Adherence exceeded 70% for both pMDIs and non-pMDIs. However, over 50% of patients prescribed rescue inhalers were classified as overusers. All prescribed short-acting β-agonists (SABAs) were delivered via pMDIs, contributing disproportionately to carbon emissions (20-30 kg CO per inhaler). Most pMDI prescriptions had viable, lower-emission non-pMDI equivalents. CONCLUSION: A substantial proportion of pMDIs prescribed for SA could be replaced with sustainable alternatives without compromising adherence. The lack of low-emission rescue inhalers highlights a critical area for future innovation in respiratory care.
Risk factors associated with hospital admission, clinical progression and 90-day mortality in adults with respiratory syncytial virus infection.
Suárez Betancourt L, Nájera A, Sango AG … +5 more , Cantero Escribano JM, Robles Fonseca L, Cordoba ES, García Guerrero J, Gonzalez-Rubio J
Respir Med · 2026 Jun · PMID 42067071 · Publisher ↗
BACKGROUND: Respiratory syncytial virus has traditionally been associated with childhood illness, but it is increasingly recognised as a cause of severe disease in adults, particularly older people and those with chronic...
BACKGROUND: Respiratory syncytial virus has traditionally been associated with childhood illness, but it is increasingly recognised as a cause of severe disease in adults, particularly older people and those with chronic comorbidities. Despite its growing clinical relevance, evidence describing outcomes and predictors of disease severity in adults remains relatively limited. AIM: To identify factors associated with hospital admission, clinical severity and 90-day mortality in adults with respiratory syncytial virus infection. METHODS: A single-centre observational cohort study was conducted including 340 adults with polymerase chain reaction-confirmed respiratory syncytial virus infection between October 2023 and September 2024. Clinical, demographic and care-related variables were analysed using multivariable logistic regression and ordinal regression models. Clinical severity was assessed using an ordinal composite outcome including non-hospitalisation, hospital admission, intensive care unit admission and death. RESULTS: Of the 340 patients, 172 (50.6%) required hospital admission and 39 (11.5%) died within 90 days. Age 65 years or older, diabetes mellitus, immunosuppression, institutionalisation and chronic heart disease were independently associated with hospital admission. Age 65 years or older and chronic kidney disease were the strongest predictors of 90-day mortality. Ordinal regression analysis showed that these factors were consistently associated with increasing clinical severity. CONCLUSION: Adults with respiratory syncytial virus infection experience substantial morbidity and mortality, particularly those who are older, have chronic comorbidities or are socially vulnerable. These findings support early risk stratification and may assist critical care and interprofessional teams in identifying patients who require closer monitoring and timely escalation of care.
Genotype-dependent biochemical response to elexacaftor/tezacaftor/ivacaftor in children with cystic fibrosis: A 24-month real-world study.
Simonetti G, Caporale R, Carreras G … +2 more , Lopes-Pacheco M, Terlizzi V
Respir Med · 2026 Jun · PMID 42067070 · Publisher ↗
BACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ETI) has revolutionized cystic fibrosis (CF) care; however, its efficacy in pediatric subjects carrying one ETI-responsive and one non-responsive CFTR variant remains incompl...
BACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ETI) has revolutionized cystic fibrosis (CF) care; however, its efficacy in pediatric subjects carrying one ETI-responsive and one non-responsive CFTR variant remains incompletely characterized. This study compared the real-world response to ETI using sweat chloride concentration (SCC) as a key biomarker of CFTR function. METHODS: In this retrospective, single-center study, pediatric subjects aged 6-18 years, carrying at least one p.Phe508del variant and on ETI, were included. Participants were stratified by genotype into those with two responsive variants and those with one responsive variant. SCC, percent predicted FEV1 (ppFEV1), BMI z-score, and pulmonary exacerbations were assessed at baseline (T0), 3-6 months (T1), 12 months (T2), and 24 months (T3). Longitudinal analyses were performed using mixed-effects models. RESULTS: Among 80 pediatric participants, those with two responsive variants had significantly lower median SCC at all follow-up time points (T1: 31.0 vs 46.0 mmol/L; T2: 26.0 vs 41.0 mmol/L; T3: 32.0 vs 45.0 mmol/L; all p < 0.01) and were more likely to achieve SCC <30 mmol/L. Regression models confirmed that carrying two responsive variants was independently associated with a 30% lower SCC (coefficient -0.36, 95% CI -0.53 to -0.18) and a 95% reduction in odds of elevated SCC (OR 0.05). No significant differences were observed in ppFEV1, BMI z-score, or pulmonary exacerbation rates. CONCLUSION: Children and adolescents with CF carrying two ETI-responsive variants exhibit a superior biochemical response to ETI. The absence of differences in clinical outcomes likely reflects preserved baseline status, reinforcing SCC as a sensitive biomarker of CFTR modulation in pediatric subjects. These findings support the use of SCC as a sensitive early biomarker of CFTR correction, particularly in pediatric patients with preserved clinical status.
The association of dyspnea and fatigue severity with physical activity and physical capacity in patients with COPD.
Tofoli TM, Dorssers B, Vaes AW … +6 more , Palmen B, Janssen DJA, Santin L, Pitta F, Van't Hul AJ, Spruit MA
Respir Med · 2026 Jun · PMID 42061476 · Publisher ↗
BACKGROUND: It is well-established that dyspnea and fatigue are barriers to physical activity (PA) and have a negative effect on physical capacity (PC) in individuals with chronic obstructive pulmonary disease (COPD). Ho...
BACKGROUND: It is well-established that dyspnea and fatigue are barriers to physical activity (PA) and have a negative effect on physical capacity (PC) in individuals with chronic obstructive pulmonary disease (COPD). However, it remains unclear how those symptoms interact on physical function and whether one holds dominance over the other. AIM: To compare physical activity and physical capacity of individuals with COPD with different severities of fatigue and dyspnea symptoms, and to identify the dominant limiting symptom of physical function. METHODS: In this cross-sectional study, individuals with COPD visiting an outpatient clinic were assessed for dyspnea (mMRC dyspnea) and fatigue (CIS-Fatigue). Key outcomes were PC (6-min walk distance, 6MWD) and daily PA (steps/day). Individuals were stratified into four groups based on severe dyspnea (yes/no, mMRC dyspnea ≥2) and/or severe fatigue (yes/no, CIS-Fatigue ≥36 points). RESULTS: 549 individuals with COPD (55% men, 64 ± 9 years, FEV 58 ± 18) were analyzed and classified as: Low dyspnea/low fatigue (LD/LF n = 186, 34%), low dyspnea/severe fatigue (LD/SF, n = 123, 22%), severe dyspnea/low fatigue (SD/LF, n = 71, 13%), severe dyspnea/severe fatigue (SD/SF, n = 169, 31%). The groups SD/LF and SD/SF had significantly worse 6MWD (413 ± 94 and 376 ± 107 m, respectively) and lower levels of daily PA (4183 [2382-6087] and 3470 [2114-5056] steps/day, respectively) when compared to the LD/LF and LD/SF groups (479 ± 75 and 475 ± 93 m; 6466 [4587-8094] and 5830 [4041-7889] steps/day, respectively) (p<.005). CONCLUSION: Individuals with COPD who experience severe dyspnea consistently exhibit worse levels of daily PA and PC compared with those who report low dyspnea, regardless of the presence or not of severe fatigue.
Insulin resistance surrogates and their associations with preserved ratio impaired spirometry in United States adults.
Zhu Q, He R, Wang F … +2 more , Hu D, Lou L
Respir Med · 2026 Jun · PMID 42061475 · Publisher ↗
BACKGROUND: Preserved ratio impaired spirometry (PRISm), characterized by a reduced forced expiratory volume in 1 s percent predicted (FEV%pred <80%) with a preserved FEV/FVC (≥0.7), represents an atypical spirometric pa...
BACKGROUND: Preserved ratio impaired spirometry (PRISm), characterized by a reduced forced expiratory volume in 1 s percent predicted (FEV%pred <80%) with a preserved FEV/FVC (≥0.7), represents an atypical spirometric pattern associated with increased risk of developing chronic obstructive pulmonary disease (COPD), as well as cardiometabolic comorbidities and mortality. Insulin resistance (IR) has been increasingly implicated in pulmonary impairment, yet its association with PRISm remains unclear. METHODS: This study utilized data from 4150 adults in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Seven IR surrogate indices were evaluated: triglyceride-glucose index (TyG), TyG-BMI, TyG-WC, TyG-WHtR, TG/HDL-C, METS-IR, and estimated glucose disposal rate (eGDR). Weighted multivariable logistic regression assessed associations between each index and PRISm. Weighted linear regression was used to examine associations with lung function parameters. Restricted cubic spline (RCS) analysis evaluated potential nonlinear trends. Subgroup and sensitivity analyses were conducted to test robustness and longitudinal analyses were performed using weighted Cox proportional hazards models. RESULTS: Of the population, 9.20% met PRISm criteria. After full covariate adjustment, higher eGDR was associated with lower PRISm risk (OR: 0.772, 95% CI: 0.703, 0.847, P < 0.001), while higher METS-IR and TyG-derived indices (TyG-WHtR: OR: 1.544, 95% CI: 1.349, 1.767, P < 0.001) were associated with increased PRISm odds. RCS analysis revealed linear associations for TyG-WC, nonlinear inverse patterns for eGDR and TyG-WHtR, and U-shaped associations for METS-IR and TyG-BMI. Subgroup interactions were most pronounced in hypertensive participants across all IR surrogates (all P-interaction <0.05). Sensitivity analyses excluding glucose-lowering, lipid-lowering, or respiratory medication users, and stratifying by self-reported health status, confirmed the high robustness of these findings. Weighted Cox models showed that, after full adjustment, TyG-WHtR (HR: 1.267, P = 0.011) and TyG-WC (HR: 1.001, P = 0.025) independently predicted all-cause mortality, with TyG-WHtR exhibiting a time-dependent increase in risk. CONCLUSION: Multiple IR surrogate markers are independently associated with PRISm and reduced lung function in adults. These findings highlight a potential metabolic component in the pathogenesis of PRISm.
Enhancing genetic diagnosis of primary ciliary dyskinesia by copy number variants analysis.
Bertini V, Pifferi M, Ramone T … +7 more , Maj D, Michelucci A, Di Cicco ME, Cambi F, Peroni D, Caligo MA, Valetto A
Respir Med · 2026 Jul · PMID 42061474 · Publisher ↗
BACKGROUND: Primary Ciliary Dyskinesia (PCD) is a rare, genetically heterogeneous disorder. Despite the increasing number of identified causative genes, 20-30% of patients still lack a genetic diagnosis. To date, genetic...
BACKGROUND: Primary Ciliary Dyskinesia (PCD) is a rare, genetically heterogeneous disorder. Despite the increasing number of identified causative genes, 20-30% of patients still lack a genetic diagnosis. To date, genetic analyses have primarily focused on single nucleotide variants (SNVs). In this study, we evaluated whether the detection of copy number variants (CNVs) improves the diagnostic yield in our large patient cohort. METHODS: We retrospectively evaluated patients with confirmed or suspected PCD who remained genetically unresolved after next-generation sequencing (NGS). CNV analysis was performed using a custom high-density array comparative genomic hybridization (aCGH) platform targeting known PCD-associated genes. RESULTS: A total of 203 patients with a clinically compatible PCD phenotype were included. NGS-based testing identified pathogenic variants in 175 cases (86.2%). The remaining 28 patients underwent aCGH analysis, which identified CNVs involving PCD-associated genes in 13 cases. Detected variants included homozygous deletions in DNAAF4, CFAP300, and CCDC39, a hemizygous deletion in DNAAF6, and heterozygous CNVs in SPAG1, ODAD4, ODAD1, DNAI2, DNAH11, and DNAH5, in combination with SNVs previously identified by NGS. The pathogenicity of these variants was supported by in silico predictions and was consistent with ciliary ultrastructural and functional abnormalities. Integration of aCGH increased the overall diagnostic yield to 92.6%. CONCLUSIONS: Targeted CNV analysis by custom aCGH increases diagnostic yield in PCD, with potential benefits for earlier diagnosis and treatment, and should be routinely implemented.
Disulfidptosis in chronic obstructive pulmonary disease: Unraveling a novel immunometabolic nexus for therapeutic targeting.
Ni FX, Hu J, Chen PS … +2 more , Huang DH, Jiang ZB
Respir Med · 2026 Jun · PMID 42061473 · Publisher ↗
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, driven by persistent inflammation, oxidative stress, and progressive tissue destruction. Current therapies alleviate symp...
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, driven by persistent inflammation, oxidative stress, and progressive tissue destruction. Current therapies alleviate symptoms but do not halt disease progression, highlighting the urgent need for novel pathogenic insights. The recent discovery of disulfidptosis, a regulated cell death driven by disulfide stress, offers a groundbreaking framework for understanding COPD. This review proposes that disulfidptosis constitutes a central pathogenic axis, creating a self-perpetuating cycle of metabolic stress, immunogenic cell death, and sterile inflammation that integrates core features of COPD. We synthesize evidence from bioinformatic analyses showing dysregulation of disulfidptosis-related genes (e.g., SLC7A11) in COPD. We detail the molecular cascade linking cigarette smoke-induced NADPH depletion to aberrant actin disulfide crosslinking and cell death. Furthermore, we explore its crosstalk with oxidative stress, DAMP-mediated inflammation, and impaired repair. Finally, we evaluate the translational potential of targeting this axis, proposing disulfidptosis signatures for patient stratification and discussing therapeutic strategies from SLC7A11 inhibition (with context-dependent or inhaled delivery) to NLRP3 inflammasome blockade and HS donors. By integrating disulfidptosis with COPD pathophysiology, this review aims to guide future research and establish this pathway as a pivotal target for developing disease-modifying therapies.
Recombinant human interleukin-7 for patients with infection-associated lymphopenia: a systematic review and meta-analysis.
Lu X, Shi Y, Chen L … +3 more , Jiang X, Wang Z, Tu Y
Respir Med · 2026 Jun · PMID 42055480 · Publisher ↗
PURPOSE: This study aims to evaluate the efficacy of recombinant human interleukin-7 (rhIL-7) in treating lymphopenia and related clinical outcomes in patients with infection-associated lymphopenia through a meta-analysi...
PURPOSE: This study aims to evaluate the efficacy of recombinant human interleukin-7 (rhIL-7) in treating lymphopenia and related clinical outcomes in patients with infection-associated lymphopenia through a meta-analysis. METHODS: A Literature retrieval was conducted across databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CNKI, Wanfang, and VIP from the inception until October 2025. Randomized controlled trials of rhIL-7 for the treatment of lymphopenia were screened and identified for eligibility. Primary outcomes included absolute lymphocyte counts (ALC), mortality, intensive care unit (ICU) length of stay, and incidence of secondary infections. RESULTS: Four studies were included, covering sepsis and COVID-19. In septic patients, rhIL-7 significantly increased ALC (MD = 1.33 at 3 weeks; 95% CI [0.29, 2.38]; MD = 1.14 at 4 weeks; 95% CI [0.02, 2.25]), CD4 T-cell counts (MD = 0.56 at 3 weeks; 95% CI [0.08, 1.05]) and CD8 T-cell counts (MD = 0.40 at 2 weeks; 95% CI [0.05, 0.76]). However, rhIL-7 failed to reduce mortality (RR = 1.01; 95% CI [0.36, 2.81]) or the incidence of secondary infections (RR = 1.05; 95% CI [0.48, 2.30]) in patients with sepsis. In patients with COVID-19, rhIL-7 did not significantly increase ALC at 30 days (MD = 0.46; 95% CI [-0.15, 1.08]) or reduce mortality (RR = 0.85; 95% CI [0.55, 1.33]), but it did significantly reduce the incidence of secondary infections (RR = 0.58; 95% CI [0.46, 0.74]; p < 0.0001). A combined analysis revealed that rhIL-7 significantly increased ALC (MD = 1.15 at 3 weeks; 95% CI [0.47, 1.84]; MD = 0.80 at 4 weeks; 95% CI [0.24, 1.36]) and reduced the risk of secondary infections (RR = 0.64; 95% CI [0.50, 0.81]), but had no effect on mortality or ICU length of stay. CONCLUSION: RhIL-7 effectively ameliorates sepsis-associated lymphopenia but does not improve prognosis. Although rhIL-7 reduces the incidence of secondary infections in COVID-19 patients, confounding factors related to the pandemic context must be taken into account.
Rapid & sustained benefit of benralizumab in severe eosinophilic asthma: the BE-REAL study.
Dupont L, Pilette C, Deschampheleire M … +13 more , Eger K, Martinot JB, Leys M, Himpe U, Peché R, Lins M, Delovinfosse S, Simonis H, Herreman A, Janssen L, Quataert C, Feys T, Louis R
Respir Med · 2026 Jun · PMID 42044815 · Publisher ↗
BACKGROUND: Benralizumab is an anti-IL-5Rα antibody used as add-on maintenance therapy in patients with severe eosinophilic asthma (SEA). MATERIALS AND METHODS: The prospective, observational BE-REAL study evaluated the...
BACKGROUND: Benralizumab is an anti-IL-5Rα antibody used as add-on maintenance therapy in patients with severe eosinophilic asthma (SEA). MATERIALS AND METHODS: The prospective, observational BE-REAL study evaluated the outcomes in SEA patients treated with benralizumab in a Belgian real-world setting. The primary objective of the study was to assess within-patient improvement of a minimum clinically important difference (MCID) in Asthma Control Questionnaire-6 (ACQ-6) (i.e., ≥0.5 units) up to 6 months (or 24 weeks). Secondary objectives include the change in ACQ-6 at weeks 56 and 112, the change in the daily oral corticosteroid (OCS) use, changes in asthma status and disease severity, healthcare resource utilization, treatment satisfaction, exacerbation rate and safety. Clinical remission rate was determined by combining the effect on asthma control, OCS use and exacerbation rate. RESULTS: 78 patients were screened, 2 were screening failures and 76 received at least one dose of benralizumab. At week 24, 71% of patients achieves an ACQ-6 response. Reductions in ACQ-6 scores were seen within 1 week of therapy. Over 112 weeks, the mean ACQ-6 score was reduced by 1.60 points (>3-fold MCID), the Annualized Exacerbation Rate (AER) was reduced by 82%, and the mean daily dose of OCS was reduced by 90%. 44% of patients in BE-REAL fulfilled the definition of clinical remission at week 56. Benralizumab was well-tolerated and associated with an improved perception of disease severity and a reduced healthcare utilization. CONCLUSION: BE-REAL provide a real-world confirmation of the clinical trial data obtained with benralizumab showing both favourable short and long-term outcomes.
Gender and diagnostic shifts in TB trends: Insights from 15-year data in Northwest China.
Salawati H, Lu Y, Li F … +3 more , Mailiman B, Zheng Y, Zhang L
Respir Med · 2026 Jun · PMID 42036051 · Publisher ↗
BACKGROUND: China faces a severe tuberculosis (TB) situation, particularly in Xinjiang. This study analyzed the influence of age, period, and birth cohort on TB incidence trends in the region. METHODS: Trends in incidenc...
BACKGROUND: China faces a severe tuberculosis (TB) situation, particularly in Xinjiang. This study analyzed the influence of age, period, and birth cohort on TB incidence trends in the region. METHODS: Trends in incidence and inflection points were analyzed using a joinpoint regression model (JPR) based on pooled data of pulmonary tuberculosis (PTB) case reports from 2006 to 2020. An age-period-cohort (APC) model based on intrinsic estimation (IE) was used to analyze the impact coefficients, which were transformed into relative risks (RR) to estimate trends. RESULTS: From 2006 to 2020, the incidence of TB in Urumqi declined at an average rate of 4% per year, according to JPR. APC analysis model showed the highest age effect at ages 20-24 years (RR = 1.81) and 80-84 years (RR = 2.22). Females aged 85-89 showed a decreasing trend in incidence, while males experienced a sharp increase. The risk of the two diagnostic types was initially the same; bacteriological diagnoses had a higher risk of morbidity (RR = 1.14) compared to clinical diagnoses during 2016-2020. The cohort effect was highest in 1973-1977 (RR = 2.71) and then declined rapidly, particularly in bacteriological diagnosis from 1978 onwards. CONCLUSIONS: While TB incidence in Urumqi has declined, young adults (20-24) and the elderly (≥70) remain high-risk groups. The effects of gender and diagnosis type varied by age, period, and cohort. These findings help identify at-risk populations and inform targeted interventions.
Medication adherence to cystic fibrosis transmembrane conductance regulator (CFTR) modulators: Analysis on the French cystic fibrosis population from 2012 to 2020.
Eid E, Payet C, Fernandez V … +5 more , Belhassen M, Bessou A, Durieu I, Reynaud Q, Viprey M
Respir Med · 2026 Jul · PMID 42036050 · Publisher ↗
BACKGROUND: Cystic fibrosis transmembrane conductance regulator (CFTR) modulators, ivacaftor and lumacaftor/ivacaftor, were introduced in France in 2012 and 2015, respectively, and transformed treatment landscape. Real-w...
BACKGROUND: Cystic fibrosis transmembrane conductance regulator (CFTR) modulators, ivacaftor and lumacaftor/ivacaftor, were introduced in France in 2012 and 2015, respectively, and transformed treatment landscape. Real-world data on medication adherence to these treatments remains limited, although crucial for effectiveness. We evaluated 1-year and 2-year medication adherence (persistence and implementation) using linked data from the French Cystic Fibrosis Registry and the French National Health Data System (SNDS), and examined determinants. METHODS: We conducted a retrospective cohort study including all French cystic fibrosis patients aged 6 years and more, initiating ivacaftor or lumacaftor/ivacaftor between 2012 and 2020, and treated for at least 6 months. Medication adherence was measured as persistence (time to discontinuation fixed to 84-day gap) and implementation (continuous multiple-interval measure of medication availability version 7; CMA-7). It was calculated over 1-year and 2-year following treatment initiation. Determinants of non-persistence (treatment discontinuation) were identified using a Cox proportional hazards model. Determinants of optimal implementation (CMA7≥0.8) were assessed with multivariate logistic regressions. RESULTS: Among 1362 patients, 95 initiated ivacaftor and 1267 initiated lumacaftor/ivacaftor, with a mean age of 19 years and 53% male. Mean time to discontinuation was 653 ± 141 days. Proportion of patients with optimal implementation at 1 year and 2 years were 79% and 75%, respectively. Age <18 years, higher socio-economic level, higher number of cotherapies, and lower percent predicted forced expiratory volume in 1 s (ppFEV1%) were associated with better treatment implementation at both 1-year and 2-years. CONCLUSIONS: Most patients on CFTR modulators showed optimal implementation with persistence declining over time, potentially affecting long-term outcomes.
Dupilumab-induced eosinophilia in severe asthma: 2-year follow-up real-life evidence from biologic-naïve and previously treated patients.
Bellver-Asperilla C, Romero Ortíz A, Cabrerizo-Carreño H … +9 more , Orozco Echeverría S, González Compta X, Golet Fors M, Andújar Ruiz A, Suárez-Cuartín G, Padullés-Zamora N, Ardanuy Tisaire C, Santos Pérez S, Muñoz-Esquerre M
Respir Med · 2026 Jun · PMID 42036049 · Publisher ↗
UNLABELLED: Data from real-life settings regarding dupilumab-associated eosinophilia remains limited, particularly concerning potential risk factors for developing hypereosinophilia after treatment initiation. METHODS: W...
UNLABELLED: Data from real-life settings regarding dupilumab-associated eosinophilia remains limited, particularly concerning potential risk factors for developing hypereosinophilia after treatment initiation. METHODS: We conducted a prospective observational study including an initial cohort of 36 patients with severe asthma treated with dupilumab and followed for up to two years. Blood eosinophil count (BEC), asthma outcomes, and treatment response - including ACT score, lung function, exacerbations, oral corticosteroid use, and the EXACTO scale as a multidimensional response measure - were assessed at baseline and at weeks 24, 52, and 104. Eosinophilia was categorized as mild (>500 cells/μL), moderate (>1500 cells/μL), or severe (>5000 cells/μL), and hypereosinophilia as moderate-severe eosinophilia. RESULTS: Transient eosinophilia occurred in 47.2% of patients and transient hypereosinophilia in 19.4%, with most cases being asymptomatic. Two patients (5.6%) developed a clinical presentation suggestive of eosinophilic granulomatosis with polyangiitis (EGPA). Hypereosinophilia was more frequent among patients who had switched from prior anti-IL-5/IL-5R therapy. Among the cases that developed hypereosinophilia, 42.9% persisted at the 2-year follow-up, whereas mild eosinophilia persisted in 65% of patients. Nevertheless, dupilumab treatment resulted in significant improvements in asthma control and treatment response outcomes, irrespective of eosinophil levels or prior biologic exposure. CONCLUSION: Eosinophilia is a common finding in patients receiving dupilumab, generally without significant safety implications. The use of dupilumab is safe and highly effective, even in patients previously treated with anti-IL-5/IL-5R biologics. However, rare cases of severe eosinophilic complications may occur, making long-term systematic monitoring advisable.
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