Respir Med [JOURNAL]
Sun
200 papers
Type 2 biomarkers outperform asthma-COPD overlap definitions in predicting clinical outcomes in COPD patients initiating triple therapy: A prospective cohort study.
Huang H, Liang H, Wang J … +8 more , Gong Z, Hu Y, Xu G, Zhao X, Huang J, Chen Y, Zhao W, Zhao H
Respir Med · 2026 Jun · PMID 41980658 · Publisher ↗
BACKGROUND: It remains uncertain whether type 2 (T2) inflammation is associated with clinical outcomes during triple therapy in chronic obstructive pulmonary disease (COPD) and whether asthma-COPD overlap (ACO) definitio...
BACKGROUND: It remains uncertain whether type 2 (T2) inflammation is associated with clinical outcomes during triple therapy in chronic obstructive pulmonary disease (COPD) and whether asthma-COPD overlap (ACO) definitions add prognostic value beyond T2 biomarkers. METHODS: This prospective cohort enrolled 201 stable COPD patients scheduled to initiate triple therapy. Patients were classified into T2-high and T2-low groups based on blood eosinophils, FeNO, and sputum eosinophils. Outcomes at 1 year included CAT, SGRQ-C, FEV, achievement of minimal important differences (MIDs), and moderate-to-severe exacerbations. Multivariable models assessed associations, adjusting for baseline values and covariates. Four ACO definitions were tested for incremental predictive performance. RESULTS: Within this cohort, T2-high was independently associated with better 1-year outcomes: lower CAT (AMD -2.31, 95% CI -3.73 to -0.88) and SGRQ-C (AMD -7.54, -11.38 to -3.70), and higher FEV (AMD +0.19 L, 0.08 to 0.29; all P ≤ 0.002). T2-high increased odds of achieving MIDs for CAT (aOR 2.78, 1.22-6.34), SGRQ-C (aOR 3.92, 1.61-9.54), and FEV (aOR 3.13, 1.55-6.30); the association with fewer exacerbations was borderline (aOR 0.44, 0.18-1.09). ACO criteria agreement was moderate (κ = 0.416), and adding ACO definitions yielded minimal predictive gain (Δ adjusted R ≤ 0.024; ΔAUC -0.001 to 0.021; DeLong P ≥ 0.25). FeNO showed more consistent dose-response associations with clinical improvement than blood eosinophil counts. CONCLUSION: Baseline T2-high status was associated with more favorable 1-year clinical outcomes during triple therapy, whereas adding ACO definitions to T2 stratification provided limited incremental prognostic value.
Biological therapy for chronic obstructive pulmonary disease (COPD): Effectiveness and safety.
García Morales OM, Díaz L, Auladell-Rispau A … +4 more , Poloni D, Torres-López LA, Cuchi GU, Rojas-Reyes MX
Respir Med · 2026 May · PMID 41974360 · Publisher ↗
INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) continue to experience exacerbations and hospitalizations despite optimal management. Biologic therapies targeting type 2 inflammatory pathways may...
INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) continue to experience exacerbations and hospitalizations despite optimal management. Biologic therapies targeting type 2 inflammatory pathways may improve clinical outcomes. We conducted a living evidence synthesis to provide a continuously updated evaluation of the effects of biologic therapies in COPD. METHODS: We systematically identified randomized controlled trials (RCT) evaluating biologic therapies in COPD patients at increased risk of exacerbations, particularly those with elevated blood eosinophil counts. Primary outcomes included annual exacerbation rate, exacerbation risk at 52 weeks, lung function, quality of life, and adverse events. Evidence was synthesized using meta-analysis, and certainty was assessed with GRADE. RESULTS: Eleven RCTs including 7359 participants were identified up to November 2025. Biologic therapy reduced the mean annual rate of COPD exacerbations (MD -0.16, 95% CI -0.23 to -0.08; high certainty) but probably did not affect exacerbation risk at 52 weeks (4241 participants; RR 1.00, 95% CI 0.94 to 1.07; moderate certainty). Effects on FEV, quality of life, and total adverse events were not clinically important. Biologics slightly reduced serious adverse events (RR 0.87, 95% CI 0.81 to 0.94; high certainty). Subgroup analyses showed that dupilumab and mepolizumab reduced annual exacerbations, and dupilumab improved SGRQ scores. CONCLUSIONS: This living evidence synthesis provides so far high-certainty evidence of biologic therapies reduce annual exacerbation rates in COPD, with a favorable safety profile. However, benefits on lung function and quality of life appear limited.
Beyond the apnea-hypopnea index: The predictive value of oxygen desaturation parameters for metabolic syndrome in OSA.
Özkeser Y, Arısoy A, Bilgin MH
Respir Med · 2026 Jun · PMID 41974359 · Publisher ↗
OBJECTIVE: The Apnea-Hypopnea Index (AHI) often correlates poorly with clinical comorbidities in Obstructive Sleep Apnea (OSA). We aimed to investigate whether one of three oxygen desaturation metrics during sleep is mor...
OBJECTIVE: The Apnea-Hypopnea Index (AHI) often correlates poorly with clinical comorbidities in Obstructive Sleep Apnea (OSA). We aimed to investigate whether one of three oxygen desaturation metrics during sleep is more or less predictive than the conventional AHI for the metabolic syndrome (MetS). METHODS: This prospective, cross-sectional study analyzed 120 consecutive patients with OSA (AHI ≥5 events/h). MetS was diagnosed based on International Diabetes Federation (IDF) criteria. Polysomnographic parameters (AHI, T90, nadir SpO, mean SpO) were compared between patients with and without MetS. Multivariate logistic regression identified independent predictors, controlling for age, gender, BMI, and cardiovascular history. RESULTS: Among the variables tested in the univariate analysis, only gender and AHI showed no significant correlation with MetS. Most variables (age, BMI, ESS score, CVD history, T90) showed significant positive correlations, while nadir and mean SpO showed significant negative correlations. In the multivariate analysis, a positive history of cardiovascular disease was the only independent predictor (OR: 7.11; p < 0.001). Compared to the univariate analysis, the three oxygen desaturation metrics (T90, mean SpO, and nadir SpO) lost significance. CONCLUSION: Although the study set was confined to patients with OSA, none of the oxygen desaturation metrics and certainly not AHI showed predictive value for MetS. Although MetS frequently occurs in patients with OSA, the main predictors remain a positive history of CVD and BMI above normal.
Subclinical myocardial injury in patients with insomnia symptoms and obstructive sleep apnea: A cross-sectional study.
Voulgaris A, Archontogeorgis K, Kalkanis A … +3 more , Chadia K, Trakada G, Steiropoulos P
Respir Med · 2026 Jun · PMID 41967656 · Publisher ↗
INTRODUCTION: Obstructive sleep apnea (OSA) is associated with cardiovascular disease (CVD). Emerging evidence suggests that OSA can lead to subclinical myocardial injury even in the absence of established CVD. We aimed...
INTRODUCTION: Obstructive sleep apnea (OSA) is associated with cardiovascular disease (CVD). Emerging evidence suggests that OSA can lead to subclinical myocardial injury even in the absence of established CVD. We aimed to evaluate the burden of subclinical myocardial injury in patients with OSA and insomnia symptoms compared to patients with OSA only. METHODS: Consecutive newly diagnosed patients with OSA and without pre-existing CVD were included in the study. All patients underwent polysomnography and completed the Athens Insomnia Scale (AIS). High- sensitivity troponin T (hs-cTnT) in the serum was measured in all participants for the evaluation of subclinical myocardial injury. RESULTS: A total of 110 patients diagnosed with OSA (aged 54.9 ± 11.4 years) were divided into two groups according to the AIS score. Group A included 50 patients without insomnia symptoms (AIS score<6) and group B included 60 patients with insomnia symptoms (AIS score≥6). The two groups had similar OSA severity (apnea hypopnea index: 40.5 ± 24.2 for group A vs 38.9 ± 24.4 for group B; p = 0.721). Serum hs-cTnT levels were significantly elevated in group B compared to group A (11.1 ± 4.7 vs. 8.2 ± 4.7 pg/mL, respectively; p = 0.001). In linear regression analysis, serum hs-cTnT levels were associated with AIS score (β = 0.456, p = 0.001) and average nocturnal oxygen saturation (β = -0.807, p = 0.006). CONCLUSIONS: The present study revealed that patients with OSA and insomnia symptoms have a greater burden of subclinical myocardial injury compared to patients with OSA only.
Exhaled breath condensate based breath analyser: Real-time thermofluidic standardisation of hydrogen peroxide for longitudinal COPD monitoring: a pilot investigation.
Chen YC, Zhang S, Hong S … +4 more , Meah S, Biddiscombe MF, Usmani OS, O'Hare D
Respir Med · 2026 Jun · PMID 41967655 · Publisher ↗
Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide, yet current monitoring strategies based on clinic spirometry and symptom reporting often fail to detect early exa...
Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide, yet current monitoring strategies based on clinic spirometry and symptom reporting often fail to detect early exacerbations. Exhaled breath condensate (EBC) offers a non-invasive alternative; however, substantial variability in biomarker concentrations has limited its clinical translation. This study aimed to quantify longitudinal variability of EBC hydrogen peroxide (HO) in healthy volunteers and COPD participants and to determine whether real-time correction for physiological sampling conditions could improve measurement consistency. We developed a handheld EBC collection device integrating temperature and inspiratory flow sensors with an on-the-fly correction algorithm to compensate for temperature- and flow-dependent heat and mass transfer effects. In artificial breath experiments, the algorithm reduced measurement variability from 20% to 7%. In a three-month longitudinal pilot study, 15 COPD participants and 15 healthy volunteers were assessed at monthly intervals (three visits per subject). HO concentrations were significantly higher in COPD participants than in healthy controls (p < 0.001), and this difference was preserved after standardisation. After standardisation, month-to-month variation in healthy volunteers was no longer statistically significant. Electrochemical detection using a Prussian blue-based sensor showed good agreement with a fluorometric reference method, with 94.8% of measurements within the 95% limits of agreement, a mean bias of 0.112 μM, and a standard deviation of 0.41 μM. Most participants rated the device as easy and comfortable to use. These findings support the technical feasibility of portable, standardised EBC HO measurement. This approach warrants further evaluation in COPD studies.
Functional and structural respiratory impairment in cerebral palsy- GMFCS IV and V: Insights from ultrasound and inspiratory muscle testing.
Varga BG, Leal FS, Figueiredo AP … +2 more , Teixeira de Carvalho EF, Dantas Gomes ELF
Respir Med · 2026 May · PMID 41962597 · Publisher ↗
BACKGROUND: Children with cerebral palsy (CP) classified at Gross Motor Function Classification System (GMFCS) levels IV and V present severe motor and respiratory impairment, which limits the feasibility of conventional...
BACKGROUND: Children with cerebral palsy (CP) classified at Gross Motor Function Classification System (GMFCS) levels IV and V present severe motor and respiratory impairment, which limits the feasibility of conventional pulmonary function testing. Non-invasive alternatives, such as diaphragmatic ultrasound and dynamic inspiratory muscle assessment, may provide clinically meaningful insights into respiratory function in this population. OBJECTIVE: To evaluate respiratory muscle strength and diaphragmatic function in children and adolescents with CP (GMFCS IV-V) and to explore correlations among inspiratory strength, flow, and ultrasound-derived parameters. METHODS: This cross-sectional study included 32 participants aged 6-17 years. Respiratory muscle strength was assessed using maximal inspiratory (PImax) and expiratory pressures (PEmax) measured with a digital manometer. Dynamic inspiratory performance was evaluated through the S-index and peak inspiratory flow (PIF) using the PowerBreathe® K5 device. Diaphragmatic thickness, excursion, contraction speed, and echogenicity were assessed by ultrasound. RESULTS: Measured PImax and PEmax were significantly lower than predicted values (p < 0.001), indicating reduced respiratory muscle strength in children and adolescents with CP classified as GMFCS IV-V. Diaphragmatic excursion was lower than reference values, particularly in those with more severe motor impairment. PImax showed moderate positive correlations with mean S-index, best S-index, and peak inspiratory flow. In the regression model, mean inspiratory volume was the main determinant of PImax, and the model demonstrated moderate explanatory power. CONCLUSIONS: Children and adolescents with severe CP (GMFCS IV-V) exhibit marked impairment in respiratory muscle strength and reduced diaphragmatic mobility. The combined use of dynamic inspiratory assessment and diaphragmatic ultrasound represents a feasible and non-invasive approach to characterize respiratory dysfunction in this population.
Active for life intervention produces a sustained increase in physical activity in people with chronic obstructive pulmonary disease.
Larson JL, Webster-Dekker KE, Dechert R … +7 more , Tucker S, Woo S, Zhou W, Gothe NP, Son JY, Ghosh B, Ploutz-Snyder RJ
Respir Med · 2026 Jun · PMID 41956174 · Publisher ↗
PURPOSE: Many older adults with chronic obstructive pulmonary disease (COPD) are inactive and moderate-to-vigorous physical activity (MVPA) can be too strenuous for long-term maintenance. We examined effects of an interv...
PURPOSE: Many older adults with chronic obstructive pulmonary disease (COPD) are inactive and moderate-to-vigorous physical activity (MVPA) can be too strenuous for long-term maintenance. We examined effects of an intervention to increase light physical activity (LPA). Primary outcomes were physical activity (PA) and sedentary behavior (SB). METHODS: Active for Life with COPD (Active-Life) is a self-efficacy-based intervention designed to increase LPA. Chair Exercises with Health Education (Chair-HE) served as an active control. PA and SB were measured with ActivPAL and ActiGraph accelerometers. RESULTS: We randomized 159 people with COPD to 10 weeks of Active-Life or Chair-HE. 128 people completed the intervention; 105 completed 1-year follow-up. The sample was 45% female, mean (SD) age was 69.6 (8.2), FEV % predicted 55.7 (14.7), and FEV/FVC 60.8 (12.3). Increases in mean (±95% CI) total PA (upright time) at end-of-intervention, 3, and 6 months relative to baseline, were 23.7 (5.0, 42.3), 21.2 (2.5, 39.9), and 29.1 (10.6, 47.7) minutes/day higher in the Active-Life compared to Chair-HE group. Step count increases at end-of-intervention, 3, 6, and 12 months were 1243 (878, 1608), 788 (421, 1155), 603 (239, 967), and 418 (43, 793) steps/day higher in Active-Life. MVPA increased at end-of-intervention, 3, 6, and 12 months: 9.7 (6.5, 12.9), 6.8 (3.8, 9.8), 4.7 (1.6, 7.7), and 2.8 (0.2, 5.5) minutes/day higher in Active-Life. No consistent changes were seen in LPA and SB. CONCLUSION: Active-Life produced significant, sustained increases in PA for 12 months. Further work is needed to reduce SB and establish longer-term PA effects.
Differences in clinical characteristics of community-acquired pneumonia with respiratory failure caused by different pathogens.
Cai X, Hang B, Zhou C … +3 more , Jiao W, Yin T, Wang J
Respir Med · 2026 May · PMID 41956173 · Publisher ↗
BACKGROUND: Respiratory failure is a serious complication of community-acquired pneumonia (CAP) that threatens children's health. In this study, the clinical characteristics of CAP with respiratory failure caused by diff...
BACKGROUND: Respiratory failure is a serious complication of community-acquired pneumonia (CAP) that threatens children's health. In this study, the clinical characteristics of CAP with respiratory failure caused by different pathogens were analyzed. METHODS: The distribution characteristics of the infectious pathogens were analyzed. Further statistical analysis of clinical data was conducted among the Mycoplasma pneumoniae (MP), respiratory syncytial virus (RSV), and bocavirus (BoV) groups. RESULTS: A total of 16 pathogens were detected, with the top three in terms of infection frequency being MP, RSV, and BoV. The duration of illness prior to hospitalization was longer in the multiple-pathogen group compared with the single-pathogen group. The duration of illness prior to hospitalization and the length of hospital stay were longer in the MP group. The distribution of abnormal imaging findings observed via radiographic examination among the MP, RSV, and BoV groups was related to the course of the illness. The MP group required the longest duration of oxygen therapy, with the majority of cases exceeding 7 days. CONCLUSIONS: In children, MP, RSV, and BoV are common pathogens associated with CAP accompanied by respiratory failure. In CAP with respiratory failure, differences in the infecting pathogens lead to variations in clinical characteristics.
Safety and efficacy of Nordic walking training in adult patients with asthma: A pilot randomised controlled trial with a mixed-methods approach.
Vilanova-Pereira M, Jácome C, Barral-Fernández M … +12 more , Guerra-Fandiño V, Zumeta-Olaskoaga L, Rial-Prado MJ, Blanco-Aparicio M, Garrido-Victorino D, Losada-García I, Arbillaga-Etxarri A, García-Boente LF, Vaes AW, Deng Q, Spruit MA, Lista-Paz A
Respir Med · 2026 May · PMID 41956172 · Publisher ↗
INTRODUCTION: Nordic walking (NW) may benefit patients with asthma by enhancing functional exercise capacity and reducing symptoms, though evidence remains limited. This study assessed NW safety and effects in patients w...
INTRODUCTION: Nordic walking (NW) may benefit patients with asthma by enhancing functional exercise capacity and reducing symptoms, though evidence remains limited. This study assessed NW safety and effects in patients with asthma and explored their experiences. METHODS: A mixed-method two-arm, parallel, pilot randomised controlled trial was conducted in A Coruña between (July 2021 - May 2025). Adults with asthma attended three educational sessions before randomization to NW group (NWG) or control group (CG). The NWG performed NW 3 days/week, during eight weeks, at 70-85% of maximum heart rate. Both groups maintained usual care. The primary outcome was the 6-min walking distance (6MWD). Secondary outcomes included 1-min Sit-to-Stand Test, physical activity (PA) and adverse events. Experiences were explored through individual interviews. RESULTS: Thirty-four participants with asthma (mean ± SD age 45.4 ± 11.4 years, 82.4% female) were randomly allocated to NWG (n = 17) or CG (n = 17). NW adherence was 80.1 + 16.1%. No adverse effects occurred. Post-intervention, the NWG increased 6MWD by 12.1 ± 30.4 m (m) (P = .119), whereas the CG decreased by 13.6 ± 41.3m (P = .193), without significant between-groups differences (P = .067; Cohen's d = 0.7; 95% confidence interval (CI) 0.-1.3). The NWG spent more time in vigorous PA compared to CG (P = .016, r = 0.4, 95% CI 0.8-52.4). All NWG participants recommended NW, citing health improvements and finding it manageable, comfortable, and implementable. CONCLUSION: Although between-groups differences were not significant, NW was safe, feasible, accessible and perceived as beneficial by individuals with asthma. Given the demonstrated safety, future studies should tailor NW intensity to fitness and asthma control levels.
Quantitative CT metrics of injury patterns among WTC workers on different longitudinal FEV trajectory groups.
Zhang Z, San José Estépar R, Doucette JT … +4 more , Weber J, Ross JC, Celedón JC, de la Hoz RE
Respir Med · 2026 May · PMID 41956171 · Full text
INTRODUCTION: We have demonstrated diverging FEV trajectories in WTC workers on longitudinal health surveillance. We performed a cohort study to investigate the association of those FEV trajectories with novel QCT marker...
INTRODUCTION: We have demonstrated diverging FEV trajectories in WTC workers on longitudinal health surveillance. We performed a cohort study to investigate the association of those FEV trajectories with novel QCT markers of subtle lung parenchymal injury. METHODS: We included WTC responders with CT scans with quantitative measurements (all as percentage of the CT-measured lung volume) of five different metrics: normal parenchyma (Norm%), high attenuation normal parenchyma (NormHA%), interstitial lung abnormality features (ILAV%), honeycombing pattern (HcV%), and emphysema. We used linear regression to calculate each subject's FEV slope and classified them into three distinct trajectories: 1) accelerated decline (ACCEL): < -62.5 mL/year; 2) normal decline (NORM): 0 to -30 ml/year, baseline FEV%predicted>70% and no significant dyspnea; 3) improved: >0 mL/year. RESULTS: Among 446 participants, 211 had ACCEL, 142 NORM, and 93 improved FEV trajectory. On chest CTs at an average of 7.5 years after 11-September-2001 and compared to the NORM subgroup, ACCEL and improved trajectory subgroups both had less normal lung tissue (Norm%), with ACCEL having more emphysema, and improved participants higher ILAV% and NormHA%. The values of HcV% were very low and not significantly different across groups. ACCEL had a significantly higher all-cause mortality. CONCLUSION: In this occupational cohort on longitudinal surveillance, accelerated lung function decline appears primarily associated with emphysema and airway disease, while lung function improvement is associated with subtle quantitative CT findings suggestive of interstitial inflammatory processes. The latter appeared largely nonprogressive at the time, as honeycombing was very infrequent and not different across trajectory subgroups.
Impact of gastroesophageal reflux and proton pump inhibitors in fibrotic interstitial lung disease.
Nalesso G, Ferranti G, Marinescu DC … +22 more , Johannson KA, Marcoux V, Fisher JH, Assayag D, Manganas H, Kolb M, Ryerson CJ, CARE-PF Investigators, Other CARE-PF investigators, Cox G, Fell CD, Gershon AS, Goobie G, Grant-Orser A, Khalil N, Lok SD, Minuk L, Morisset J, Sadatsafavi M, Shapera S, To T, Wong AW
Respir Med · 2026 May · PMID 41951189 · Publisher ↗
INTRODUCTION: The role of gastroesophageal reflux disease (GERD) and proton pump inhibitors (PPI) in fibrotic interstitial lung disease (fILD) remains unclear. We evaluated the association of GERD and PPI use with cough...
INTRODUCTION: The role of gastroesophageal reflux disease (GERD) and proton pump inhibitors (PPI) in fibrotic interstitial lung disease (fILD) remains unclear. We evaluated the association of GERD and PPI use with cough severity and major pulmonary outcomes in patients with fibrotic ILD. METHODS: This retrospective analysis of a prospective cohort study consisted of patients with fibrotic ILD enrolled in the CAnadian REgistry for Pulmonary Fibrosis. Patients were categorized by the presence of GERD and PPI use based on patient self-report and verified by review of the medical record. We evaluated the unadjusted and adjusted association of GERD and PPI use with cough severity visual analog scale (VAS), change in lung function, and mortality. RESULTS: 2238 patients with fILD were included, of whom 731 had idiopathic pulmonary fibrosis. GERD was present in 777 patients (35%), with 494 (64%) of these reporting PPI use. GERD was associated with worse baseline cough severity VAS [36 mm (21-59) vs 30 mm (17-55), p = 0.007), with no difference between PPI users and non-users (p = 0.89). There was no consistent association of GERD or PPI use with change in lung function or transplant-free survival, with PPI use tending to be associated with worse outcomes only upon adjustment for age, sex, body mass index, and smoking pack-years (HR 1.31, 95%CI 1.02-1.67, p = 0.03). CONCLUSIONS: GERD is associated with worse cough severity in fILD, but PPI use is not associated with less cough. Neither GERD nor PPI use was consistently associated with change in lung function or transplant-free survival.
Safety and tolerability of the low global warming potential propellant HFA-152a in patients with asthma receiving beclometasone dipropionate/formoterol fumarate/glycopyrronium: The TRECOS study.
Singh D, Mancini L, Melis G … +3 more , Cortellini M, Rostello C, Mathews KS
Respir Med · 2026 May · PMID 41951188 · Publisher ↗
BACKGROUND: Propellants currently used in pressurised metered-dose inhalers (e.g., HFA-134a) are being replaced by low global warming potential alternatives, including HFA-152a. This study aimed to assess the bronchocons...
BACKGROUND: Propellants currently used in pressurised metered-dose inhalers (e.g., HFA-134a) are being replaced by low global warming potential alternatives, including HFA-152a. This study aimed to assess the bronchoconstriction potential and the safety and tolerability of triple combination beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G) HFA-152a pMDI compared to BDP/FF/G HFA-134a pMDI. METHODS: Adults with moderate-to-severe controlled asthma received BDP/FF/G HFA-134a pMDI for a two-week run-in, then were randomised 1:2 to either continue the HFA-134a pMDI formulation or switch to the HFA-152a pMDI formulation, both for 12 weeks. The primary objective was to compare the bronchoconstriction potential of BDP/FF/G HFA-152a vs HFA-134a in terms of the relative change from pre-dose in forced expiratory volume in 1 s (FEV) at 10 min post-dose on Day 1. Safety and tolerability assessments included adverse event occurrence. RESULTS: Of 553 patients randomised to treatment, 539 (97.5%) completed the study (356/368 [96.7%] and 183/185 [98.9%] with the HFA-152a and HFA-134a formulations, respectively). There was no difference between the two groups for the primary endpoint, with an adjusted mean (95% confidence interval) HFA-152a vs HFA-134a difference of -1.143% (-2.769%, 0.483%). A total of 19.3% patients experienced adverse events with the HFA-152a formulation (71/368) compared to 27.6% with the HFA-134a formulation (51/185); most events with both formulations were mild or moderate in severity. CONCLUSIONS: Overall, transitioning to the low global warming potential HFA-152a formulation had no impact on the safety and tolerability of BDP/FF/G, with the positive effect on lung function comparable to the original HFA-134a formulation.
The evolving science of ventilation heterogeneity: From pathophysiology to personalized therapeutic approaches.
Barjaktarevic I, Kuhn B, Cooper CB
Respir Med · 2026 May · PMID 41951187 · Publisher ↗
Although inherent to normal lung physiology, ventilation heterogeneity (VH) often becomes an underrecognized clinical problem in a variety of respiratory conditions characterized by an asymmetric distribution of patholog...
Although inherent to normal lung physiology, ventilation heterogeneity (VH) often becomes an underrecognized clinical problem in a variety of respiratory conditions characterized by an asymmetric distribution of pathologic processes and the presence of regional mismatching between ventilation and perfusion. Traditional functional diagnostic approaches have been mostly focused on the role of VH in airway diseases, but with the development of novel diagnostic approaches capable of diagnosing both temporal and spatial VH in lung disease, we have the opportunity to better understand the clinical significance of VH in all lung disease. In this concise review, we aim to discuss the physiologic, radiologic, and clinical impacts of VH on pulmonary disease, highlighting the developing technologies to detect and treat it.
Prognostic impact of emphysema extent on mortality and lung function decline in combined pulmonary fibrosis and emphysema: An observational cohort study.
Anderson MR, Porteous MK, Hsu WC … +2 more , Lin CT, Johnson C
Respir Med · 2026 May · PMID 41951186 · Publisher ↗
BACKGROUND: Combined pulmonary fibrosis and emphysema (CPFE) is a well-recognized syndrome characterized by the coexistence of emphysema and fibrotic interstitial lung disease (ILD) and is associated with high mortality....
BACKGROUND: Combined pulmonary fibrosis and emphysema (CPFE) is a well-recognized syndrome characterized by the coexistence of emphysema and fibrotic interstitial lung disease (ILD) and is associated with high mortality. However, the prognostic significance of emphysema extent relative to fibrosis pattern remains incompletely defined. METHODS: We conducted an observational cohort study of participants with fibrotic ILD and radiographic emphysema. Baseline high-resolution computed tomography (HRCT) scans were independently assessed by two thoracic radiologists using a standardized semi-quantitative scoring system. Cox proportional hazards regression was used to evaluate associations between imaging features and all-cause mortality. RESULTS: Ninety-two participants with CPFE were followed for a median of 8 years, during which 70% died. Cumulative mortality was 4.4% at 1 year, 21.7% at 3 years, and 30.5% at 5 years. Most participants demonstrated a definite usual interstitial pneumonia pattern and centrilobular emphysema, with the majority having <5% emphysema involvement. In multivariable analysis, emphysema extent was the only imaging feature independently associated with mortality. Participants with >5% emphysema had a significantly higher risk of death (HR 3.96, 95% CI 1.43-10.95; p = 0.008). Fibrosis pattern, emphysema subtype, and regional disease distribution were not independently associated with mortality. CONCLUSION: Semi-quantitative emphysema extent on HRCT is a strong, independent prognostic marker in CPFE. These findings support routine assessment of emphysema burden to inform risk stratification in CPFE.
Exploring AI and ML in managing overlap between cardiovascular disease and asthma or COPD: a scoping review.
Calzetta L, Cazzola M, Pistocchini E … +3 more , Gholamalishahi S, Laitano R, Rogliani P
Respir Med · 2026 May · PMID 41941973 · Publisher ↗
Cardiovascular disease (CVD) is a major comorbidity in asthma and chronic obstructive pulmonary disease (COPD), yet the contribution of artificial intelligence (AI) and machine learning (ML) to CVD risk assessment and ma...
Cardiovascular disease (CVD) is a major comorbidity in asthma and chronic obstructive pulmonary disease (COPD), yet the contribution of artificial intelligence (AI) and machine learning (ML) to CVD risk assessment and management in these conditions remains insufficiently characterized. This scoping review identified the main original full-text studies applying AI/ML to the overlap between CVD and asthma or COPD for prediction, phenotyping or clinical decision support. Among the eleven identified studies, only one specifically addressed asthma, developing ML-based CVD risk prediction models from electronic health records that achieved good short-term discrimination but lacked external validation. The remaining studies focused on COPD and CVD, employing supervised learning, deep-learning survival analysis, natural language processing, unsupervised clustering and AI-enabled clinical decision support. Across these investigations, COPD and related comorbidities consistently emerged as strong predictors of CVD events, mortality and adverse clinical trajectories. Unsupervised clustering revealed COPD-dominant heart failure phenotypes with particularly poor outcomes, while AI-derived risk models frequently provided superior discrimination and calibration compared with traditional statistical approaches. However, most studies were retrospective, largely reliant on structured data, limited in generalizability and rarely implemented in routine care. Overall, current evidence indicates substantial potential for AI/ML to enhance CVD risk stratification, phenotyping and management in COPD, whereas applications in asthma are strikingly scarce. These findings underscore a critical need for large-scale, prospectively evaluated and clinically integrated AI/ML strategies to improve detection, risk stratification and personalized management of CVD in patients with asthma or COPD.
Prognostic value of the dead space fraction in invasive mechanical ventilation using the Enghoff equation - a single center retrospective cohort study.
Rietveld PJ, van den Meiracker BTRM, Brunsveld-Reinders AH … +4 more , Smits FE, Snoep JWM, van Westerloo DJ, Schoe A
Respir Med · 2026 May · PMID 41941972 · Publisher ↗
BACKGROUND: The physiological dead space fraction, particularly when estimated with the Enghoff equation, reflects global gas exchange by integrating all aspects of V/Q mismatch. Elevated dead space fractions have been a...
BACKGROUND: The physiological dead space fraction, particularly when estimated with the Enghoff equation, reflects global gas exchange by integrating all aspects of V/Q mismatch. Elevated dead space fractions have been associated with worse outcomes in ARDS, but their prognostic value beyond ARDS remains unclear. OBJECTIVES: To evaluate the prognostic value of the dead space fraction, calculated using the Enghoff equation, for hospital mortality among critically ill patients in the ICU. STUDY DESIGN AND METHODS: This single center retrospective cohort study included adults ≥18 (years) ventilated for ≥24 h in the ICU of Leiden University Medical Center (October 2018 and September 2024). The Enghoff ratio was calculated from volumetric capnography and arterial blood gases, averaged over the first 24 h. The primary outcome was hospital mortality; time until extubation was secondary. Cox regression with adjustment for APACHE IV score, Body Mass Index (BMI) and gender; non-linear effects were modeled using restricted cubic splines. RESULTS: Higher Enghoff ratios were independently associated with increased hospital mortality (Chi = 16.32, df = 2, p < 0.001, adjusted HR 1.42, 95% CI 1.22-1.67). The relationship was non-linear, with risk rising above 70%. No significant association was found with time until extubation (Chi = 2.54, df = 2, p = 0.280; HR 1.01, 95% CI 0.89-1.08). CONCLUSION: The Enghoff ratio was independently associated with hospital mortality in mechanically ventilated ICU patients, particularly above 70%. Although not predictive for time until extubation, it may serve as a complementary marker of gas exchange impairment and aid in risk stratification.
Tumour seeding after transbronchial biopsy: Mechanisms, clinical implications, and prevention strategies-A narrative review.
Prabhu Prasad NC
Respir Med · 2026 May · PMID 41936937 · Publisher ↗
Tumour seeding, defined as the inadvertent transplantation and proliferation of malignant cells during diagnostic or therapeutic procedures, is a rare but clinically significant complication of transbronchial biopsy (TBB...
Tumour seeding, defined as the inadvertent transplantation and proliferation of malignant cells during diagnostic or therapeutic procedures, is a rare but clinically significant complication of transbronchial biopsy (TBB). TBB includes conventional forceps biopsy (CFB), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and cryobiopsy, and is widely used for diagnosing pulmonary and mediastinal lesions. As bronchoscopic procedures become increasingly important for early-stage cancer diagnosis, understanding this rare event is essential. This review synthesised evidence from PubMed, Google Scholar, Embase, and Scopus (January 2000 to August 2025) on TBB-related seeding, following established narrative review methodology. A total of 58 publications, including case reports, case series, and reviews, were analyzed. Only four well-documented cases of tumour seeding were identified, highlighting the extreme rarity of this complication. Seeding developed one week to four months after TBB, most often involving adenocarcinoma or squamous cell carcinoma. The true incidence remains unknown but was considered far lower than that of percutaneous biopsy approaches (0.6-2.7% for transthoracic needle aspiration). True incidence cannot be reliably calculated from case reports alone; however, bronchoscopic approaches appeared substantially safer than transthoracic needle aspiration. Mechanistic risk factors are largely extrapolated from non-bronchoscopic biopsy procedures owing to limited TBB-specific data. Despite scarce evidence, enhanced awareness, informed consent and systematic surveillance are recommended as the diagnostic benefits of TBB clearly outweighed the minimal seeding risk. Future multicentre registries with long-term follow-up are crucial for better quantifying incidence and informing evidence-based preventive strategies.
Endotype of chronic rhinosinusitis with nasal polyps in Morocco: A cross-sectional multicentric study.
Darouassi Y, Chebraoui Y, Tayane M … +11 more , Hanine MA, En-Nouali A, Nakkabi I, Aourarh S, El Assead TO, Hakki F, El-Akhiri M, Benchafai I, Aljalil A, Touati M, Ammar H
Respir Med · 2026 May · PMID 41936936 · Publisher ↗
OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type of chronic rhinosinusitis involving persistent inflammation of the nasal and sinus cavities accompanied by polyps. New classifications define endotyp...
OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type of chronic rhinosinusitis involving persistent inflammation of the nasal and sinus cavities accompanied by polyps. New classifications define endotypes of this condition based on molecular and cellular biomarkers of inflammation. A better understanding of CRSwNP's pathophysiology has led to the development of monoclonal antibody-based biotherapies that specifically target inflammatory biomarkers involved in this pathology. With the advent of these biotherapies, endotyping has become increasingly important for optimal, personalized therapeutic strategies. While the inflammatory profile in the United States, Europe, Australia, and Japan is predominantly eosinophilic (type 2), Asian countries have a mixed profile, including a predominantly neutrophilic inflammatory response. Our goal was to determine the prevalence of the type 2 inflammatory response among Moroccan patients with CRSwNP by using blood eosinophil levels as a biomarker. MATERIALS AND METHODS: We conducted a cross-sectional prevalence study at four Moroccan hospitals, including 48 patients with CRSwNP. We defined the type 2 endotype according to the 2023 EPOS/EUFOREA criteria using blood eosinophil counts of at least 150 cells/mm. RESULTS: Among our patients, 93.8% demonstrated a type 2 endotype (95% confidence interval: 82.8% - 98.7%). The median age was 54.5 years (range, 22-73), and the male-to-female ratio was approximately 1.5:1. CONCLUSION: The predominant endotype of CRSwNP in our population appears to be type 2. However, these results need to be confirmed by multicenter studies on a larger scale to refine therapeutic indications and better adapt management to our regional specificities.
Lung ultrasound for acute respiratory distress syndrome diagnosis: A systematic review and meta-analysis.
Sreedharan JK, Alqahtani AS, Albalawi IA … +6 more , Alanazi ZA, Alquaimi M, Alghamdi MA, Alkhaldi WA, Alahmari AD, Jose AM
Respir Med · 2026 May · PMID 41935702 · Publisher ↗
BACKGROUND/OBJECTIVES: Acute respiratory distress syndrome (ARDS) requires prompt diagnosis. Lung ultrasound (LUS) is a non-invasive tool with potential diagnostic value, but its accuracy needs systematic evaluation. MET...
BACKGROUND/OBJECTIVES: Acute respiratory distress syndrome (ARDS) requires prompt diagnosis. Lung ultrasound (LUS) is a non-invasive tool with potential diagnostic value, but its accuracy needs systematic evaluation. METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science (inception-December 2024) identified studies assessing LUS for ARDS using established reference standards. Data were extracted independently, and a random-effects meta-analysis was performed to calculate diagnostic odds ratios (DOR), sensitivity, specificity, likelihood ratios, and AUROC. RESULTS: This meta-analysis included 16 studies with 5888 patients, demonstrating that lung ultrasound (LUS) is a reliable diagnostic tool for ARDS. The pooled diagnostic odds ratio was 14.98 (95% CI, 9.81-22.88; p < 0.001), with a sensitivity of 0.75 (95% CI, 0.62-0.85) and specificity of 0.87 (95% CI, 0.80-0.91). The positive and negative likelihood ratios were 4.89 (95% CI, 3.67-6.52) and 0.15 (95% CI, 0.11-0.21), respectively, while the AUROC was 0.91 (95% CI, 0.88-0.93). Substantial heterogeneity was noted (I = 75.2%), with higher diagnostic performance observed in ICU settings, studies using ≥8-zone scanning protocols, and those focusing on severe ARDS. Meta-regression identified scanning zones and operator experience as key sources of heterogeneity. The presence of bilateral B-patterns with ≥3 B-lines per intercostal space showed the highest specificity (0.92; 95% CI, 0.87-0.96). CONCLUSIONS: This meta-analysis demonstrated that LUS has good diagnostic accuracy for ARDS (pooled DOR 14.98, sensitivity 0.75, specificity 0.87, AUROC 0.91). Higher diagnostic performance was observed with ≥8-zone scanning protocols, in ICU settings, and for severe ARDS. The modest sensitivity indicates that negative LUS findings should not exclude ARDS diagnosis. CLINICAL IMPLICATIONS: Lung ultrasound (LUS) provides a rapid, bedside, and radiation-free diagnostic option for ARDS, offering good accuracy, especially in ICU and resource-limited settings. Comprehensive scanning protocols and trained operators enhance reliability, supporting LUS integration into clinical practice where advanced imaging is unavailable.
Elexacaftor/tezacaftor/ivacaftor is safe and effectively reduces sino-nasal symptoms in people with cystic fibrosis post lung transplantation.
Mathiesen IHM, Rönsholt FF, Aanæs K … +8 more , Bille J, von Buchwald C, Jensen-Fangel S, Qvist T, Katzenstein TL, Bendstrup E, Perch M, Jeppesen M
Respir Med · 2026 Jun · PMID 41935701 · Publisher ↗
BACKGROUND/AIM: This investigator-initiated, open-labelled study describes safety and extrapulmonary outcomes of elexacaftor/tezacaftor/ivacaftor (ETI) treatment in people with cystic fibrosis after lung transplantation...
BACKGROUND/AIM: This investigator-initiated, open-labelled study describes safety and extrapulmonary outcomes of elexacaftor/tezacaftor/ivacaftor (ETI) treatment in people with cystic fibrosis after lung transplantation (pwCF + LTX), with particular focus on sino-nasal symptoms. ETI has not been systematically administered to people with cystic fibrosis after lunge transplantation (pwCF + LTX) due to lack of data from this subgroup and concerns about potential interactions with immunosuppressive therapy. METHODS: All pwCF + LTX in Denmark were screened for eligibility and included participants were treated with ETI in standard dosages for 24 weeks, with examinations before and after ETI initiation. Eligibility criteria were at least one F508del mutation, estimated glomerular filtration rate (eGFR) above 30 ml/min/1,73m2, ≤Child-Pugh class B, did not already receive ETI, contraception usage for women, life expectancy exceeding study duration, and considered able to adhere to safety protocol. Safety was determined by calcineurin inhibitor (CNI) trough levels, biochemical markers of organ failure, adverse events, and hospital admissions. Examinations included blood samples (including trough levels of immunosuppressants), Sino-nasal Outcome Test 22 (SNOT-22), smell test, nasal endoscopy score and sinus CT scan, sweat test and spirometry. RESULTS: Of the 36 pwCF + LTX screened, 24 were eligible and 17 accepted to participate. Five participants ended ETI treatment before study completion because of side effects, most commonly dizziness, flu-like symptoms, sleep problems, and gastrointestinal symptoms. The study showed striking effects on sino-nasal symptoms based on a significantly reduced sinonasal symptom score (SNOT-22) and CT scores; further, the ability to smell improved objectively and nasal endoscopy showed reductions in polyp size, edema and discharge. No effects were found on weight, HbA1C, and FEV1 % predicted. Most participants required reduction in CNI dose, but management of immunosuppression was uncomplicated. CONCLUSION: ETI has a dramatic effect on sino-nasal symptoms and can safely be co-administered with CNI with careful monitoring of trough levels.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe