Pulmonary Therapy最新文献

{"title":"Potential Public Health Impact of Updated COVID-19 Vaccination Strategies in Thailand: Epidemiological Data Update.","authors":"Karan Thakkar, Ruangwit Thamaree, Moe H Kyaw, Iustina Chirila, Carlos Fernando Mendoza, Josie Dodd, Ben Yarnoff, Sasisopin Kiertiburanakul","doi":"10.1007/s41030-026-00358-x","DOIUrl":"10.1007/s41030-026-00358-x","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates the anticipated health and economic effects of multiple COVID-19 vaccination strategies using an updated vaccine in Thailand.</p><p><strong>Methods: </strong>A previously published hybrid decision tree and Markov model, originally developed for the USA, was calibrated using Thailand-specific epidemiological, demographic, and economic data from 2024. The model assessed several age- and risk-based vaccination strategies assuming vaccine uptake ranging from 20% to 50%. Health outcomes (cases, hospitalizations, deaths, and long COVID cases) and economic outcomes (long COVID costs, direct medical costs, and productivity losses) were projected from payer and societal perspectives. Vaccine effectiveness was assumed to be 50% against infection, 60% against symptoms, and 70% against severe disease, with a 6-month duration of protection.</p><p><strong>Results: </strong>Vaccinating individuals aged 60 years and above and high-risk individuals aged 6 months to 59 years was projected to prevent 318,700 infections, 9147 hospitalizations, and 1061 deaths in 1 year. This strategy was estimated to yield THB 3300 million in direct medical cost savings and THB 2695 million in productivity loss savings. Increasing coverage in this population to 50% could amplify these reductions by up to 150%.</p><p><strong>Conclusions: </strong>With updated Thai data, analyses suggest that use of an adapted COVID-19 vaccine could continue to generate considerable public-health and economic gains, particularly when coverage among older adults and high-risk groups is expanded. These findings carry implications for sustaining preparedness and guiding national vaccination policy.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"573-584"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Three Devices Preventing Skin Damage During Facial Mask Ventilation in Acute Respiratory Failure: Multicenter Randomized Controlled Trial Protocol (3PROSNIVtrial).","authors":"Raffaele Scala, Federica Andolfi, Giulia Ottaviano, Teresa Renda, Elena Ceparano, Manuela Caneschi, Luca Guidelli, Maria Laura Vega, Lara Pisani, Ilaria Bassi, Alfredo Aprile, Stefania Bertini, Daniela Bonanni, Patrizia Zoccali, Michele Vitacca, Luca Barbano, María Torrano Ferrández, Ana Rozúa López, Genoveva Ruiz Villa, Santino A Marchese, Geraldine Lo Grasso, Elisabetta Fiandra, Elvio Scoscia, Amir Eslami, Emanuela Albo, Stefano Baglioni, Nicola Facciolongo, Claudia Castagnetti, Chiara Barbieri, Fabio Boccafoglio, Sonia Viola, Antonio M Esquinas","doi":"10.1007/s41030-026-00364-z","DOIUrl":"10.1007/s41030-026-00364-z","url":null,"abstract":"<p><strong>Background: </strong>In patients with acute respiratory failure (ARF) undergoing noninvasive ventilation (NIV), pressure-related skin injury is among the most frequent and clinically relevant complications. The reported prevalence of device-related pressure injuries is estimated at around 25%, while reported incidences of NIV-related facial pressure ulcers range from approximately 10-31%. These lesions, mainly localized over the nasal bridge, arise because the skin in this area is thin and supported by minimal subcutaneous tissue, making it highly vulnerable to ischemic and frictional forces exerted by the mask interface. In severe cases, skin breakdown may lead to pain, infection, or discontinuation of NIV, thereby compromising ventilatory support. The most commonly adopted preventive strategy involves the application of shaped hydrocolloid dressings; however, evidence regarding their actual effectiveness and the potential benefits of alternative protective devices remains limited.</p><p><strong>Objectives: </strong>The primary aim of this study is to compare skin injury-free survival in ARF patients receiving NIV treated with three different CE-marked protective systems. Secondary objectives include assessing device stability and protective performance, patient comfort, pain intensity, mask tolerance, timing and staging of skin lesions, cost-effectiveness, predictive factors for skin injury, and overall NIV success.</p><p><strong>Methods: </strong>This is a multicenter, randomized, open-label, controlled trial involving 14 Italian pulmonology intensive care units and 1 Spanish Intensive Care Unit. Eligible patients with hypoxemic or mixed hypoxemic-hypercapnic ARF requiring NIV for more than 24 h will be randomly assigned to one of four study arms (three intervention groups and one control group). Each group will receive a different protective device-Tegaderm^®, Duoderm^®, or Allevyn Adhesive^®-or standard care. Lesion grading, pain assessment, and device performance will be evaluated using standardized scoring systems.</p><p><strong>Planned outcomes: </strong>The trial will provide comparative evidence on the efficacy of different protective dressings in preventing NIV-related facial skin injury, thereby supporting the development of evidence-based recommendations for clinical practice.</p><p><strong>Trial registration: </strong>NCT01351155.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"721-731"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global pMDI Use and the Potential Impact of European PFAS Legislation on Access to These Essential Inhaled Medications.","authors":"Janwillem W H Kocks, Tim Harrison, John P Bell, Andy Rignall, Mina Khezrian, Omar S Usmani","doi":"10.1007/s41030-026-00362-1","DOIUrl":"10.1007/s41030-026-00362-1","url":null,"abstract":"<p><strong>Introduction: </strong>Many essential inhaled medicines recommended in guidelines are delivered to the lung via pressurized metered-dose inhalers (pMDIs). Global environmental legislation will lead to phasing out of hydrofluoroalkane propellants currently used in pMDIs, owing to their global warming potential (GWP). Furthermore, the European Chemicals Agency is reviewing proposed legislation to ban per- and polyfluoroalkyl substances (PFAS) on the basis of chemical structure, which could also impact pMDI availability. Here, we estimated pMDI use as a proportion of all inhaler use in 60 countries, spanning six geographical regions, to understand the relevance of any pMDI restrictions to patients and prescribers.</p><p><strong>Methods: </strong>pMDI use as a percentage of total inhaler use during 2022 was calculated by country and geographical region using inhaler sales data (a surrogate of use) from the IQVIA Quarterly MIDAS database; inhaler use for the 10-year period from 2013 to 2022 was also evaluated for these regions. Data were compared by individual inhalations. The total patient population living with asthma and/or chronic lower respiratory disease was calculated on the basis of Eurostat (the statistical office of the European Union [EU]) 2019 data and available disease prevalence statistics. Maintenance pMDI utilization was estimated by adjusting for ratio of maintenance pMDI use to total inhaler use.</p><p><strong>Results: </strong>Across all countries analyzed, pMDIs accounted for the largest proportion of inhaler use in 2022 (77.3%). In 51 out of 55 countries with available country-level data, pMDIs represented > 50% of total inhaler use. After adjusting for pMDI usage, an estimated 8.1 million EU patients received a maintenance pMDI in 2022, with the greatest proportion in Germany and France.</p><p><strong>Conclusions: </strong>pMDIs are vital inhalers for most patients in Europe and around the world. While transitioning to near-zero or low-GWP inhalers, it is essential to avoid unintended consequences from the proposed PFAS ban by safeguarding patient access to this essential device option.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"653-666"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Single-Inhaler Triple Therapy FF/UMEC/VI on Disease Stability in COPD: A Real-World 12-Month Analysis.","authors":"Chiara Lupia, Daniela Pastore, Antonio Giacalone, Federica Marrelli, Lucia Novelli, Debbie Riccelli, Angelantonio Maglio, Giuseppe Armentaro, Angela Sciacqua, Alessandro Vatrella, Girolamo Pelaia, Corrado Pelaia","doi":"10.1007/s41030-026-00368-9","DOIUrl":"10.1007/s41030-026-00368-9","url":null,"abstract":"<p><strong>Introduction: </strong>Single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic or experience exacerbations despite dual bronchodilation. However, real-world evidence on its ability to achieve multidimensional \"disease stability\", integrating symptoms, lung function, and exacerbation outcomes, remains limited. The aim of our study was therefore to evaluate, in a real-world cohort of exacerbating patients with COPD, the effects of once-daily FF/UMEC/VI on lung function, respiratory symptoms, health status, and exacerbation rates over 12 months.</p><p><strong>Methods: </strong>This retrospective single-center study included 86 adults with COPD treated with FF/UMEC/VI 92/55/22 µg at the Respiratory Unit of \"Magna Graecia\" University Hospital (Catanzaro, Italy). Lung function tests (forced expiratory volume in the first second, FEV₁; forced vital capacity, FVC; forced mid-expiratory flow between 25% and 75% of FVC, FEF_25-75; residual volume, RV; total lung capacity, TLC; corrected single-breath diffusion lung capacity for carbon monoxide, DLCOcSB) were performed at baseline and after 12 months. Symptoms and health status were assessed using the COPD Assessment Test (CAT). Moderate and severe exacerbations were recorded within the previous 12 months and 12 months after treatment initiation. Safety and tolerability were monitored via monthly phone follow-up.</p><p><strong>Results: </strong>Eighty-six patients were included (24 women, 28%; 62 men, 72%), with a mean age of 72.29 ± 9.20 years and a median BMI of 30 (26.00-36.50) kg/m². After 12 months of FF/UMEC/VI, lung function significantly improved: FEV₁ increased from 1.46 ± 0.51 l to 1.61 ± 0.60 l (p < 0.01), FEV₁/FVC from 0.65 ± 0.11 to 0.69 ± 0.11 (p < 0.001), and FEF_25-75 from 0.84 (0.54-1.15) l/s to 0.99 (0.71-1.53) l/s (p < 0.001). Pulmonary hyperinflation decreased, with RV declining from 2.90 (2.25-3.80) l to 2.50 (1.72-3.20) l (p < 0.0001). DLCOcSB increased from 4.59 ± 1.36 to 4.86 ± 1.53 mmol/min/kPa (p < 0.05). CAT score improved from 25.99 ± 4.03 to 22.93 ± 5.76 (p < 0.0001). The number of moderate/severe exacerbations decreased from 2.08 ± 0.66 to 0.15 ± 0.36, and 63 patients (73%) met the composite criteria for COPD disease stability.</p><p><strong>Conclusions: </strong>In this real-world cohort of exacerbating patients with COPD, once-daily single-inhaler FF/UMEC/VI was associated with improved lung function, reduced hyperinflation, better symptom control, enhanced quality of life, and a significant reduction in exacerbation frequency. These findings suggest that FF/UMEC/VI may be a useful therapeutic option for supporting multidimensional disease stability in high-risk patients with COPD, although prospective controlled studies are needed to confirm these observations.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"691-705"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes in Concurrent Cohorts of Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA)-Treated versus ELX/TEZ/IVA-Ineligible Individuals with Cystic Fibrosis in the US during COVID-19.","authors":"Christian A Merlo, Hela Romdhani, Maral DerSarkissian, Aruna Muthukumar, Lisa J McGarry, Yiyue Lou, Kate Van Brunt","doi":"10.1007/s41030-026-00363-0","DOIUrl":"10.1007/s41030-026-00363-0","url":null,"abstract":"<p><strong>Introduction: </strong>The initial US launch of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) coincided with the coronavirus disease 2019 (COVID-19) pandemic, altering healthcare-seeking behaviors and possibly resulting in decreased respiratory infection transmission. We evaluated real-world effectiveness of ELX/TEZ/IVA, accounting for potential impact of COVID-19 by comparing outcomes in people with cystic fibrosis (CF) treated with ELX/TEZ/IVA with ELX/TEZ/IVA-ineligible people with CF.</p><p><strong>Methods: </strong>This retrospective, observational study used US CF Foundation Patient Registry data (2017-2021) of people with CF aged ≥ 12 years initiating ELX/TEZ/IVA between Q4 2019 and Q3 2021 and a concurrent comparator cohort ineligible for ELX/TEZ/IVA. Primary outcomes (follow-up through 2021 or death) included change in percent predicted forced expiratory volume in 1 s (ppFEV₁) from baseline over follow-up, annualized rate of ppFEV₁ decline, rate of pulmonary exacerbations (PEx), time to lung transplantation, and overall survival.</p><p><strong>Results: </strong>ppFEV₁ increased in ELX/TEZ/IVA-treated individuals through follow-up but decreased in the comparator cohort (+6.20 versus -3.13 percentage points, respectively; mean difference 9.34, 95% confidence interval [CI] 8.84 to 9.85). The annualized rate of ppFEV₁ change was -0.03 (95% CI -0.18 to 0.07) in the ELX/TEZ/IVA-treated cohort and -2.24 (95% CI -2.66 to -1.80) in the comparator cohort (relative reduction in rate of decline of 99%; 95% CI 92-103%). Rates of PEx requiring intravenous antibiotics or hospitalization were 0.17 and 0.77 among ELX/TEZ/IVA-treated and comparator cohorts, respectively (77% reduction, 95% CI 74-81%). Proportion undergoing lung transplant was 0.22% and 2.94% in ELX/TEZ/IVA-treated and comparator cohorts, respectively (90% reduction, 95% CI 29-98%). All-cause mortality was 0.76% and 3.45% in ELX/TEZ/IVA-treated and comparator cohorts, respectively (79% reduction; 95% CI 56-88%).</p><p><strong>Conclusions: </strong>During COVID-19, ELX/TEZ/IVA-ineligible people with CF experienced lung function decline and higher rates of PEx, lung transplant, and death versus the ELX/TEZ/IVA-treated cohort, despite infection prevention measures, suggesting ELX/TEZ/IVA's benefits remain despite the potential bias from protective effects of the pandemic.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"599-615"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate Change and the Switch from Pressurised Metered-Dose Inhalers to Dry Powder Inhalers: A Proportionate Balancing of Risk and Reward?","authors":"Sanjeeva Dissanayake, Jason Suggett, Alan Kaplan","doi":"10.1007/s41030-026-00355-0","DOIUrl":"10.1007/s41030-026-00355-0","url":null,"abstract":"<p><p>Urgent action is required to limit the increase in global temperatures. While mitigation efforts are primarily directed at transitioning away from fossil fuels, given their overwhelming contribution to greenhouse gas emissions, infrastructural change is slow to effect. Thus, behavioural changes, which can be effected rapidly, are also critical. To limit healthcare-related emissions, a widespread transition away from pressurised metered-dose inhalers (pMDIs), containing hydrofluorocarbons with high global warming potential (GWP), to dry powder inhalers (DPIs) with minimal GWP, has been proposed. This paper discusses whether the stated grounds for this transition are robust and are proportionate to the potential environmental gain and, while not to be ignored, whether a greater emphasis should be placed upon other measures that may have a greater impact.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"413-423"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interrelationship between Daytime Functional Outcomes and Psychological Distress in Patients with Obstructive Sleep Apnea: A Cross-Sectional Study.","authors":"Khue Bui-Diem, Nguyen Van Tho, Thu Nguyen-Binh, Quynh Doan-Truc, Sy Duong-Quy","doi":"10.1007/s41030-026-00365-y","DOIUrl":"10.1007/s41030-026-00365-y","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is associated with decreased daytime functional outcomes and increased psychological stress. However, the specific profile of this burden, particularly in the Vietnamese population, remains understudied. This study aimed to analyze sleep-related functional outcomes and psychological stress in a population of untreated Vietnamese patients with OSA.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 61 untreated patients with OSA (78.7% male, mean age 47.8 ± 12.9 years). Participants completed the 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) and the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Descriptive statistics, Spearman correlation coefficients, and a generalized linear model were used to assess the prevalence of symptoms and the relationship between functional and psychological domains.</p><p><strong>Results: </strong>The majority of the study population presented with severe OSA (mean apnea-hypopnea index [AHI], 47.5 ± 25.5 events/h). The median total score for FOSQ-10 was 16.3 (interquartile range [IQR]: 14.0-18.3). A notable finding was the high prevalence of clinically significant (moderate or higher) psychological distress, including depression, anxiety, and stress (22.9%, 54.1%, and 18.0%, respectively). Multivariate regression demonstrated that age was positively associated with FOSQ-10 general productivity but negatively associated with intimacy, whereas AHI was negatively associated with intimacy. FOSQ-10 and DASS-21 scores showed consistent negative correlations across all domains, indicating that diminished sleep-related functional quality of life correlates with elevated psychological distress.</p><p><strong>Conclusions: </strong>In untreated Vietnamese patients with OSA, the prevalence of psychological discomfort, especially anxiety, is considerable and is associated with significant functional impairment. The substantial association between low functional quality of life and high levels of psychological distress shows how important it is to do thorough baseline examinations. Routine assessment for functional impairment and psychological distress should be integral components of the clinical evaluation for patients with OSA.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"585-597"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Clinical Questionnaires for Predicting Obstructive Sleep Apnea in Patients with Non-Valvular Atrial Fibrillation.","authors":"Thu Nguyen Ngoc Phuong, Thanh V Kim, Duong Hiep Ho, Thuong Thanh Phuong, Nguyen Thi Le Trang, Tran Thanh Tuyen, Bui Dan Que, Doan Thi Hoa, Ngo Thi Thanh Thao, Sy Duong-Quy","doi":"10.1007/s41030-026-00356-z","DOIUrl":"10.1007/s41030-026-00356-z","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is common but frequently underdiagnosed in patients with atrial fibrillation (AF), particularly in low- and middle-income countries, where access to polysomnography is limited. This study evaluated the diagnostic accuracy of the STOP-BANG, Berlin, and Epworth Sleepiness Scale (ESS) questionnaires for OSA screening in Vietnamese patients with non-valvular AF.</p><p><strong>Methods: </strong>This cross-sectional diagnostic accuracy study was conducted in a tertiary inpatient cardiology department in Ho Chi Minh City, Vietnam. Consecutive adults with chronic non-valvular AF completed the STOP-BANG, Berlin, and ESS questionnaires, followed by overnight unattended type III polysomnography (ApneaLink™, ResMed). OSA was defined as an apnea-hypopnea index ≥ 5 events/hour according to International Classification of Sleep Disorders (ICSD)-3 criteria. Diagnostic performance was assessed using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), predictive values, and likelihood ratios.</p><p><strong>Results: </strong>Among 126 participants (median age 61 years; 45.2% male vs. 54.8% female), OSA prevalence was 74.6%. STOP-BANG showed the highest diagnostic accuracy (AUC 0.903, 95% confidence interval [95% CI] 0.852-0.954), with sensitivity of 81.9% and specificity of 96.9%. The Berlin questionnaire demonstrated moderate performance (AUC 0.824, 95% CI 0.735-0.914; sensitivity 89.4%; specificity 59.4%). ESS performed poorly in this population (AUC 0.499, 95% CI 0.386-0.613; sensitivity 6.4%).</p><p><strong>Conclusions: </strong>STOP-BANG demonstrated superior diagnostic accuracy and practicality for OSA screening in patients with non-valvular AF, supporting its use to guide referrals for confirmatory sleep testing in resource-limited settings.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"561-572"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of BMI on the Effect of Biologic Agents for Severe Asthma.","authors":"Styliani Papadopoulou, Christodoulos Komiotis, Fotios Drakopanagiotakis, Stelios Loukides, Paschalis Steiropoulos","doi":"10.1007/s41030-026-00352-3","DOIUrl":"10.1007/s41030-026-00352-3","url":null,"abstract":"<p><strong>Introduction: </strong>The association between severe asthma and obesity is well established, as higher body mass index (BMI) is associated with higher prevalence and incidence of severe asthma. Biologic agents have been recently developed for severe asthma treatment. However, the efficacy of biologic agents in patients with higher BMI is not well studied. The aim of this systematic review was to determine whether there is an association between BMI and the response to five novel biologic agents.</p><p><strong>Methods: </strong>Our study design followed the PRISMA guidelines. A literature search was performed using the PubMed/Medline and the Scopus databases up to May 2025 for the following agents: mepolizumab, benralizumab, dupilumab, reslizumab, and tezepelumab. After meticulous screening, 21 articles were selected.</p><p><strong>Results: </strong>Studies on mepolizumab showed that higher BMI was associated with failure to achieve clinical remission, while BMI < 30 kg/m² was associated with better clinical outcomes. Regarding benralizumab, significant improvements were observed in respiratory symptoms and reductions in annual asthma exacerbation rate for patients with BMI ≤ 35 kg/m² but not for patients with BMI > 35 kg/m². One study about dupilumab describes it as equally effective across all BMI levels. Reslizumab appears to be effective across different BMI levels; however, effectiveness seems to decrease in patients with high BMI. Regarding tezepelumab, no study was found.</p><p><strong>Conclusions: </strong>Biologic agents are effective treatments for severe asthma, although mepolizumab, benralizumab, and reslizumab appear to have better results in patients with lower BMI. Dupilumab appears to be equally effective across all BMI categories, while no data are available for tezepelumab. More studies in patient populations with severe asthma and comorbid obesity are needed to evaluate the effectiveness of biologic therapies in this specific category of patients.</p><p><strong>Trial registration: </strong>Registration and protocol: PROSPERO CRD42024609708.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"437-462"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Airways Disease Adversely Impacts the Response to Biologic Therapies in Severe Asthma.","authors":"Chiara Allegrini, Elisa Bentivegna, Alessia Catalisano, Greta Insalata, Rubina Giulia Girolamo, Martina Maria Marinato, Luca Paita, Alessandra Sorano, Chiara Marzi, Clara De Filippis, Federico Lavorini, Gianna Camiciottoli","doi":"10.1007/s41030-026-00353-2","DOIUrl":"10.1007/s41030-026-00353-2","url":null,"abstract":"<p><strong>Introduction: </strong>Small airways disease (SAD) is increasingly recognized as a relevant trait in severe asthma, but its influence on outcomes with biologic therapies remains uncertain. We assessed the prevalence of SAD and its association with real-world treatment response in a severe asthma cohort. We hypothesized that baseline SAD, particularly when identified by oscillometry, would be associated with non-response to biologic therapy over 12 months.</p><p><strong>Methods: </strong>This single-center, retrospective cohort included adult severe asthma outpatients initiating biologic therapy. At enrolment, participants underwent clinical and biomarker evaluation, complete lung function testing (spirometry/plethysmography), and the Forced Oscillation Technique. SAD was defined by the coexistence of ≥ 1 oscillometry abnormality and ≥ 1 spirometry/plethysmography abnormality. \"Non-responders\" were defined as patients experiencing ≥ 2 exacerbations during 12-month follow-up. Multivariable logistic regression was used to identify independent predictors of response, adjusting for biologic therapy and key confounders (including BMI).</p><p><strong>Results: </strong>The analytic sample comprised 156 patients (aged 55 ± 18 years, 91 females) treated with omalizumab (n = 60), benralizumab (n = 23), mepolizumab (n = 32), or dupilumab (n = 41). After 12 months, 24/156 patients (15%) were classified as non-responders. At baseline, SAD was present in 69/156 patients (44%) and was more prevalent in non-responders than in responders (75% vs. 40%, p < 0.01). Non-responders showed worse spirometric indices (FEV₁% and FEV₁/VC) and more abnormal oscillometry (lower X5exp and higher ΔXrs, R5exp, and R5-R19). In multivariable models adjusted for biologic and key confounders, baseline oscillometry abnormalities were independently associated with a reduced odds of response (adjusted OR 0.08, 95% CI 0.02-0.37; p = 0.001).</p><p><strong>Conclusions: </strong>In a real-world severe asthma cohort, baseline SAD, particularly when identified by oscillometry, was associated with subsequent non-response to biologic therapy, suggesting potential value for risk stratification.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"535-547"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}