Pulmonary Therapy最新文献

{"title":"Real-World Outcomes in Patients with COPD Initiating Budesonide/Glycopyrronium/Formoterol Fumarate Dihydrate After Dual and Triple Therapy in Spain: A Sub-Study of the ORESTES Study.","authors":"Juan Marco Figueira-Gonçalves, Bernardino Alcázar-Navarrete, Raquel Casitas-Mateo, Jessica González, Carolina María Gotera-Rivera, Alberto Herrejón-Silvestre, Juan Margallo-Iribarnegaray, Marta Martín-Lana, Abel Pallarés-Sanmartín, Sergi Pascual-Guardia, Alberto Saura-Vinuesa, Carmen Corregidor-García, Eunice Fitas, Joaquín Sánchez-Covisa","doi":"10.1007/s41030-026-00341-6","DOIUrl":"10.1007/s41030-026-00341-6","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic obstructive pulmonary disease (COPD) is a progressive lung condition associated with high morbidity and mortality. Single-inhaler triple therapy (SITT), such as budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF), is recommended for patients with COPD who are not adequately controlled by dual therapy (DT). Escalation from DT or switching from triple therapy (TT)-SITT or multiple-inhaler TT (MITT)-are key real-world treatment pathways.</p><p><strong>Methods: </strong>The observational, retrospective, multicenter ORESTES study included adults (≥ 40 years) with COPD initiating BGF in routine clinical practice. This secondary analysis focuses on the following treatment pathways: escalation from DT and switch from TT. Patients' characteristics, exacerbations, additional COPD treatments, and healthcare resource utilization (HCRU) were assessed.</p><p><strong>Results: </strong>A total of 295 patients escalated from DT and 356 switched from TT (SITT: 147; MITT: 209) to BGF. 66.8% of patients escalating from DT and 78.5% switching from TT showed a high-risk GesEPOC phenotype; 77.9% and 80.0% had mMRC grade ≥ 2, and 91.2% and 96.1% had ≥ 3 comorbidities. Following BGF initiation, the annualized exacerbation rate decreased by 11.6% (from 1.06 to 0.94) in patients escalating from DT and by 15.5% (from 1.60 to 1.35) in patients switching from TT (after SITT: 17.8% reduction; after MITT: 14.1%). Rescue medication use declined overall, and specifically short-acting beta-2 agonists (SABA) use declined by 23.2% and 19.4% (SITT: 21.9%; MITT: 18.4%). Emergency room visits and hospitalizations decreased by 19.7% and 19.0% in patients escalating from DT, and by 29.4% and 25.5% among those switching from TT (SITT: 25.0%/18.3%; MITT: 32.4%/29.9%).</p><p><strong>Conclusions: </strong>In this real-world Spanish cohort of patients with COPD not adequately controlled with DT or TT, reductions in exacerbations, rescue medication use, and HCRU were observed after BGF initiation, supporting the potential value of earlier introduction of BGF in patients with persistent symptoms and/or frequent exacerbations despite high-intensity therapy.</p><p><strong>Clinical trial registration: </strong>NCT06321731.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"329-349"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998974","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":"Dupilumab Versus Mepolizumab for COPD: Evaluating Efficacy Outcomes Using Placebo-Adjusted Indirect Treatment Comparison.","authors":"Surya P Bhatt, Nick Freemantle, Mena Soliman, Jigna Heble, Yann Cabon, Ernesto Mayen Herrera, Joe Yang, Yingxin Xu","doi":"10.1007/s41030-025-00322-1","DOIUrl":"10.1007/s41030-025-00322-1","url":null,"abstract":"<p><strong>Introduction: </strong>Up to 40% of patients with chronic obstructive pulmonary disease (COPD) exhibit elevated blood eosinophils, reflective of type 2 inflammation. Dupilumab and mepolizumab versus standard of care have demonstrated moderate-to-severe exacerbation reductions of 30-34% and 15-18%, respectively, over 52 weeks. This study compared their relative efficacy using indirect treatment comparison (ITC).</p><p><strong>Methods: </strong>A Bucher ITC was performed on 52-week phase 3 trials of dupilumab (BOREAS/NOTUS) and mepolizumab (MATINEE/METREX/METREO). The primary ITC endpoint was annualized moderate-to-severe exacerbation rates in patients from BOREAS + NOTUS versus MATINEE + METREX (modified intention-to-treat high stratum cohort, representing an eosinophilic phenotype); sensitivity analyses were performed using different combinations of mepolizumab data including MATINEE + METREX + METREO (100-mg arm). Other 52-week endpoints included mean difference in pre-bronchodilator forced expiratory volume in 1 s (FEV₁), proportion of St. George's Respiratory Questionnaire (SGRQ) improvement ≥ 4 points, proportion of Evaluating Respiratory Symptoms in COPD (E-RS:COPD) improvement ≥ 2 points, and annualized severe exacerbation rate. Rate ratios (RRs)/odds ratios (ORs) with 95% confidence intervals (CIs) are reported.</p><p><strong>Results: </strong>The primary ITC resulted in an RR of 0.82 (95% CI 0.66, 1.01), showing a numerical advantage for dupilumab versus mepolizumab in reducing moderate-to-severe exacerbation. Sensitivity analyses confirmed findings from the primary ITC (BOREAS + NOTUS vs. MATINEE + METREX + METREO: RR 0.83 [95% CI 0.68, 1.01]). Dupilumab demonstrated significantly greater FEV₁ improvement (mean difference 83.4 mL [95% CI 36.1, 130.7]) and proportion of E-RS:COPD improvement ≥ 2 points (OR 1.76 [95%CI 1.20, 2.54]), with a numerical difference favoring dupilumab for the proportion of SGRQ improvement ≥ 4 points (OR 1.16; [95% CI 0.86, 1.56]) and for annualized severe exacerbation rate (RR 0.61 [95% CI 0.33, 1.13]) versus mepolizumab.</p><p><strong>Conclusion: </strong>This ITC suggests potential clinical benefits of dupilumab over mepolizumab in reducing exacerbations and improving lung function, respiratory symptoms, and quality of life in patients with COPD and type 2 inflammation. Direct head-to-head trials are necessary to confirm these results and better guide treatment choices.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"201-217"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150649","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":"Real-World Impact of Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) in Italy: A Retrospective Study from a Cystic Fibrosis Center.","authors":"Marco Cipolli, Teja Thorat, Pia C Pafundi, Alessandro Roggeri, Daniela P Roggeri, Carlotta Rossi, Emily Pintani, Ilaria Meneghelli, Francesca Lucca, Anna Fratoni, Gabriela Vega-Hernandez","doi":"10.1007/s41030-025-00334-x","DOIUrl":"10.1007/s41030-025-00334-x","url":null,"abstract":"<p><strong>Introduction: </strong>In Italy, elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) in combination with ivacaftor was reimbursed starting July 2021 for use in people with cystic fibrosis (CF) aged ≥ 12 years homozygous for F508del mutation or heterozygous with at least one F508del allele and with a minimal function mutation. This study assessed the impact of ELX/TEZ/IVA on real-world outcomes among this population in Italy.</p><p><strong>Methods: </strong>This observational study used data from Verona CF Center from October 2018 to December 2022 to describe the impact of ELX/TEZ/IVA on individuals aged ≥ 12 years with ≥ 1 F508del allele on lung function and healthcare resource utilization (HCRU). Lung function (percent predicted forced expiratory volume in 1 s [ppFEV₁]), hospitalizations, outpatient visits, pulmonary exacerbations (PEx), and prescribed medications were analyzed during baseline and follow-up periods (12 months pre- and post-ELX/TEZ/IVA initiation, respectively) and reported as change from baseline.</p><p><strong>Results: </strong>A total of 149 individuals were included (mean [standard deviation, SD] age: 32.6 [12.25] years). A mean improvement in ppFEV₁ of +14.38 percentage points (95% confidence interval [CI] 12.65; 16.10) was observed during the follow-up period. An 87.2% reduction in the annualized PEx rate (rate ratio: 0.128 [95% CI 0.085; 0.187]) and an 85.4% reduction in the annualized hospitalization rate (rate ratio: 0.146 [95% CI 0.096; 0.213]) were observed during follow-up compared to baseline. Reductions in the proportion of individuals requiring prescription medications, including intravenous antibiotics, mucolytic agents, and bronchodilators, were observed.</p><p><strong>Conclusion: </strong>Substantial improvements in lung function and reductions in HCRU were observed after treatment with ELX/TEZ/IVA in the Verona CF Center. Results contribute to the growing evidence of country-specific real-world data on the positive impact of ELX/TEZ/IVA.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"265-282"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669140","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":"Potential Public Health Impact of Updated COVID-19 Vaccination Strategies in Malaysia: Epidemiological Data Update.","authors":"Karan Thakkar, Moe H Kyaw, Sharlini Surendran, Iustina Chirila, Carlos Fernando Mendoza, Masliyana Husin, Peter Seah Keng Tok, Vivek Jason Jayaraj, Sheamini Sivasampu, Josie Dodd, Ben Yarnoff","doi":"10.1007/s41030-025-00329-8","DOIUrl":"10.1007/s41030-025-00329-8","url":null,"abstract":"<p><strong>Introduction: </strong>This study estimated the potential public health and economic impacts of different COVID-19 vaccination strategies in Malaysia using an updated COVID-19 vaccine.</p><p><strong>Methods: </strong>A previously published Markov decision-tree model (2021-2022) was updated with the latest epidemiology data from Malaysia (October 2022-September 2023). This updated model was used to assess the outcomes of alternative vaccination strategies using the updated COVID-19 vaccine. Age-specific inputs were derived from Malaysian epidemiological data and published sources. The model projected health outcomes (cases, hospitalizations, and deaths) and economic outcomes (direct medical costs and productivity losses) across various age and risk categories.</p><p><strong>Results: </strong>Vaccinating individuals aged 60 and above, as well as high-risk individuals aged 6 months to 59 years with vaccine coverage of 20%, was projected to prevent 91,824 infections, 1477 hospitalizations, and 53 deaths. The model estimated total savings of MYR 90.9 million in direct medical costs attributed to COVID-19 treatment and MYR 110.4 million in indirect costs attributed to COVID-19 illness. Expanding coverage among individuals aged 60 and above, as well as high-risk individuals of any age, to 50% could further increase the reduction in deaths, hospitalizations, infections, and costs by up to 150%.</p><p><strong>Conclusions: </strong>When considering recent updated epidemiology data and expected vaccination coverage, vaccination strategies appear to have a smaller impact, largely caused by the reduction in vaccine coverage. However, despite this, using an updated COVID-19 vaccine could still reduce the health and economic burden of COVID-19 in terms of cases, hospitalizations, deaths, direct medical costs, and indirect productivity losses in Malaysia, especially among high-risk populations and older adults.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"237-249"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426451","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":"Nonpharmacologic Care of Bronchiectasis: Addressing Frailty with Nutrition and Physical Activity.","authors":"Chetana Pendkar, Amarpreet K Ahluwalia","doi":"10.1007/s41030-025-00328-9","DOIUrl":"10.1007/s41030-025-00328-9","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchiectasis is a chronic airway disease marked by recurrent infections, progressive inflammation, and declining pulmonary function. While pharmacologic therapies remain central to management, nonpharmacologic strategies-particularly nutrition and physical activity-are underutilized, despite growing evidence.</p><p><strong>Objective: </strong>This review examines the role of nutritional support and physical activity in managing bronchiectasis, highlighting their impact on frailty, systemic inflammation, and functional outcomes.</p><p><strong>Discussion: </strong>Frailty is increasingly recognized in bronchiectasis, particularly in patients with comorbid nontuberculous mycobacterial lung disease (NTM-LD), where prevalence may exceed 40%. Malnutrition, low body mass index (BMI), and sarcopenia are associated with poorer lung function, increased hospitalizations, and mortality. Meanwhile, physical inactivity-measured by low step count and prolonged sedentary time-is a strong predictor of exacerbation risk and healthcare utilization. Evidence supports the use of high-calorie, protein-rich diets and resistance-based exercise training to improve muscle mass, immune function, and quality of life. Synergistic effects are observed when nutritional interventions are combined with pulmonary rehabilitation. However, barriers to implementation remain, including a lack of access, under-referral, and limited emphasis on guidelines.</p><p><strong>Conclusion: </strong>Nutritional and physical activity interventions offer measurable clinical benefits in bronchiectasis and should be integrated into routine multidisciplinary care. Future research should prioritize the validation of frailty screening tools, the implementation of effective strategies, and the development of policy mechanisms to expand coverage for dietetic and rehabilitation services.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"13-24"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409990","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":"Real-World Treatment Patterns and Burden of Chronic Thromboembolic Pulmonary Hypertension Patients across Consultation Settings in the USA.","authors":"Belinda Rivera-Lebron, Alison Witkin, Carly J Paoli, Mark Small, Mia Harvey, Daniel Graham, Sumeet Panjabi, Gabriela Gomez Rendon, Josanna Rodriguez-Lopez","doi":"10.1007/s41030-025-00337-8","DOIUrl":"10.1007/s41030-025-00337-8","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive pulmonary hypertension characterized by chronic fibrotic thrombi. Treatment includes surgical, endovascular, and pharmaceutical options. With varied treatments, it is essential to understand how they are deployed across real-world settings. We aimed to describe clinical characteristics, treatment patterns, and quality of life across real-world settings in the USA.</p><p><strong>Methods: </strong>Data were drawn from the Adelphi Real World CTEPH Disease Specific Program™, a cross-sectional survey of US physicians and patients, conducted September 2023-May 2024. Physicians recruited by local fieldwork agents using a short screening questionnaire provided demographics, clinical characteristics, and treatment patterns for 1-6 consecutively consulting patients with right heart catheterization confirmed CTEPH. These patients self-completed a form containing the EQ-5D-5L, visual analog scale (EQ-VAS), workplace and activity impairment scale (WPAI), pulmonary arterial hypertension symptom and impact scale. Data were stratified by treatment setting (accredited or nonaccredited pulmonary hypertension center). Analyses were descriptive.</p><p><strong>Results: </strong>In total, 98 physicians provided data on 153 patients, of whom 53 completed the patient self-complete form. Mean (standard deviation) patient age was 59.2 years, 59.5% female, and 73.2% considered operable. Of those who had undergone a surgery/procedure (n = 68), 82.1% had undergone pulmonary thromboendarterectomy (PTE), and 19.1% balloon pulmonary angioplasty (BPA). Overall, 82.4% were prescribed any pharmaceutical medication for their CTEPH; of those treated, 81.0% were prescribed anticoagulants. Monotherapy (45.7%) was the most reported regimen in nonaccredited settings; for accredited settings, this was dual therapy (45.5%). EQ-5D-5L scores were low with nearly a quarter of patients reporting problems with usual activities and mobility, and 26.4% needing to change work patterns.</p><p><strong>Conclusions: </strong>Though treatment patterns generally followed guidelines, BPA was potentially underutilized. Dyspnea was common, despite treatment, with patients experiencing reduced quality of life, highlighting an unmet need.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"301-316"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775657","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":"Home-Based FeNO Monitoring with the Vivatmo me Device Reveals Type 2 Inflammatory Patterns of Patients with Asthma at Different Treatment Steps: The FeNO@Home Study.","authors":"Kai M Beeh, Tim Harrison, Enrico Heffler, Hartmut Timmermann, Stephan Weber, Sandra Wegner","doi":"10.1007/s41030-025-00336-9","DOIUrl":"10.1007/s41030-025-00336-9","url":null,"abstract":"<p><strong>Introduction: </strong>Fractional exhaled nitric oxide (FeNO) is an important type 2 (T2) asthma biomarker. Home-based FeNO monitoring can provide longitudinal data better reflecting the variable nature of T2 inflammation versus single-point data. We sought to compare longitudinal mean FeNO and variability (CV) in relation to asthma control, and to compare detection rate of T2_FeNO inflammation at diagnostic (≥ 40 ppb in GINA 1) and on-treatment (≥ 25 ppb in GINA 2-5) cutoffs during home versus clinic measurements.</p><p><strong>Methods: </strong>This was an observational study with once-daily home-based FeNO (Vivatmo me) and symptom diary in patients with asthma of different GINA steps performed over 3 months. Clinic FeNO, forced expiratory volume in 1 s (FEV₁), and 5-item asthma control questionnaire (ACQ-5) scores were also collected at two visits (enrolment/study end).</p><p><strong>Results: </strong>We enrolled 85 patients (n = 23 step 1, n = 37 steps 2-3, and n = 25 steps 4-5). Mean FeNO over 3 months was highest in uncontrolled steps 4-5 (p = 0.006), and FeNO variability in steps 2-3 (p = 0.046). Subjects with optimal control (ACQ < 0.75 both visits) had comparable mean FeNO values, but fewer patients with CV above the median vs. suboptimally controlled patients (39.1% vs. 54.1%; p = 0.03). In GINA 1, FeNO CV was lower in optimally controlled patients (p = 0.10). Mean FeNO was higher on symptomatic asthma days, particularly in step 1 (p = 0.002), with similar trends during loss of asthma control phases. Home FeNO increased the detection rate of T2_FeNO inflammation at a diagnostic cutoff (≥ 40 ppb, step 1) from 8.7% (clinic FeNO) to 47.8% of subjects, and of on-treatment T2_FeNO inflammation in GINA steps 2-3 and 4-5 from 58.3% to 83.3%, and 64% to 96%, respectively.</p><p><strong>Conclusion: </strong>Home-based FeNO provides important information about airway inflammation, distinct and complementary to symptom control. Detection of T2_FeNO inflammation is facilitated at all GINA steps at diagnostic and predictive/prognostic cutoffs, with important implications for management and diagnosis.</p><p><strong>Trial registration: </strong>German Clinical Trial Register (DRKS) DRKS00029118, registered July 1, 2022.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"283-300"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725460","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":"Switching to the Dry Powder Inhaler: Disease Control with a Lower Carbon Footprint.","authors":"Christer Janson, Hanna Hisinger-Mölkänen, Lilla Tamasi, Ville Vartiainen, Lauri Lehtimäki","doi":"10.1007/s41030-025-00319-w","DOIUrl":"10.1007/s41030-025-00319-w","url":null,"abstract":"<p><strong>Introduction: </strong>Dry powder inhalers (DPIs) have a 20-40-fold lower carbon footprint compared to pressurized metered-dose inhalers (pMDIs). Switching from pMDI to DPI is therefore beneficial from an environmental perspective, but many health care professionals are concerned that this may worsen treatment outcomes in asthma and chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>We analyzed patient outcomes and carbon footprints of switching inhaler treatment from pMDI to DPI. We performed a post hoc analysis on clinical outcomes data from a 12-week real-world, non-interventional study of adult patients with asthma or COPD who switched treatment from pMDI to the budesonide-formoterol Easyhaler DPI. Clinical end points included asthma control test (ACT), Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ), lung function tests, and reliever use (asthma), and COPD assessment test (CAT), and modified Medical Research Council dyspnea scale (mMRC) (COPD). In the carbon footprint calculation, we used estimates from the Montreal Protocol for pMDI and for DPI the estimate as reported.</p><p><strong>Results: </strong>Among all 237 patients (142 asthma, 95 COPD) by switching their treatment clinical improvements were observed in all the outcome measures (p < 0.001). Furthermore, the need for reliever medication decreased among patients with asthma (p < 0.001). The amount of estimated kg CO₂e emissions per year for maintenance treatment was 97.0% lower for the DPI than for pMDI. For reliever medication among patients with asthma, it was 99.6% lower. Among them, the emission savings could amount to approximately 131 kg CO₂e annually. This is of similar magnitude, as individual high-impact environmental actions such as eating a plant-based diet or purchasing green energy.</p><p><strong>Conclusions: </strong>Our results show that disease control was maintained among patients with asthma or COPD when they switched from pMDI to DPI, while the carbon footprint of inhaler treatment was reduced.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"753-763"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233235","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":"Real-World Adherence and Persistence of Upfront Therapy in Patients with Pulmonary Arterial Hypertension in the United States.","authors":"Teresa De Marco, Carly J Paoli, Nicole S Croteau, Fei Tang, Harrison W Farber","doi":"10.1007/s41030-025-00311-4","DOIUrl":"10.1007/s41030-025-00311-4","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary arterial hypertension (PAH) is a rare, progressive disease resulting from elevated pulmonary arterial pressure leading to right ventricular failure and death. Optimal adherence and persistence to medical therapy are necessary to improve outcomes. The objective of this study was to characterize adherence and persistence to first-line PAH therapies in patients newly initiating treatment.</p><p><strong>Methods: </strong>This retrospective cohort study utilized Komodo Research Database claims data. Adults initiating therapy were identified based on ≥ 1 claim for a phosphodiesterase 5 inhibitor (PDE5i) and/or an endothelin receptor antagonist (ERA) from January 1, 2017, to June 30, 2022 (index date), continuous medical and pharmacy health plan enrollment for ≥ 12 months before and including index, ≥ 1 inpatient or ≥ 2 outpatient claims for pulmonary hypertension/PAH, and ≥ 1 claim for right heart catheterization. Adherence was measured by proportion of days covered (PDC); nonadherence was defined as PDC < 80%. Persistence was defined as time from index to treatment discontinuation (gap in therapy > 60 days). Propensity score matching was utilized 1:1:1 across groups.</p><p><strong>Results: </strong>A total of 9176 patients met the study criteria (6989 PDE5i, 1006 ERA, 1181 dual combination). After matching, each cohort included 714 patients. Median (95% confidence interval) persistence was highest for ERA monotherapy (26.5 [19.0-33.0] months), followed by dual combination therapy (19.8 [16.6-23.4] months) and PDE5i monotherapy (12.9 [10.8-17.4] months)-P = 0.019, dual combination versus ERA; P = 0.026, dual combination versus PDE5i. Nonadherence was highest with dual combination therapy (35.4%), followed by PDE5i monotherapy (17.1%) and ERA monotherapy (11.9%)-P < 0.001, dual combination versus each monotherapy.</p><p><strong>Conclusions: </strong>Adherence to initial PAH therapy is suboptimal, especially with upfront dual combination therapy. Persistence was highest for ERA monotherapy, followed by dual combination therapy and PDE5i monotherapy. Strategies to improve adherence and persistence are crucial to optimizing outcomes.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"587-604"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006558","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 Flow Restrictors on Aerosol Delivery of the Respimat® Soft Mist Inhaler.","authors":"Moritz Fleischhauer, Kai Berkenfeld, David Stadermann, Sitaram Velaga, Igor Gonda, Peter Langguth, Herbert Wachtel","doi":"10.1007/s41030-025-00312-3","DOIUrl":"10.1007/s41030-025-00312-3","url":null,"abstract":"<p><strong>Introduction: </strong>The modification of an inhaler's air flow resistance influences a patient's inhalation flow profile, thereby affecting the exit velocity of an aerosol leaving the Respimat® mouthpiece. A slower inhalation maneuver results in reduced plume velocity and thus a decreased oropharyngeal deposition due to reduced impaction. This could not only lead to fewer unwanted side effects associated with inhaled therapies, but also enhance lung deposition.</p><p><strong>Methods: </strong>Device prototypes with different air flow resistances were designed using custom-made inserts that can be clipped into the Respimat mouthpiece. The consequences on aerosol characteristics, as well as on in vitro deposition, were analyzed. Computational fluid dynamics simulations contributed to a better understanding of the modified aerodynamic conditions.</p><p><strong>Results: </strong>Different insert geometries resulted in modified device resistances. However, an increased flow resistance does not necessarily result in an improved in vitro performance. The flow restrictors critically determine aerosol characteristics such as plume velocity and spray pattern, thereby altering in vitro deposition patterns. Quantitative data on mouth-throat deposition and aerosol characteristics are reported.</p><p><strong>Conclusions: </strong>Integrating flow restrictors into the Respimat mouthpiece offers a promising approach to enhance patient centricity by promoting slower inhalation, thereby reducing the likelihood of suboptimal use. The use of a porous insert acting as a diffuser demonstrated minimal impact on internal airflow dynamics and in vitro deposition, suggesting that such designs can support correct inhalation technique without compromising aerosol performance. By minimizing the influence of patient-dependent factors, this strategy may help standardize the inhalation process and improve therapeutic outcomes. Video Abstract available for this article. Video Abstract (MP4 85313 KB).</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":"605-623"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034065","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}