Respiratory investigation最新文献

{"title":"Leveraging the 10th-percentile lower limit of normal for FEV1/FVC to facilitate early identification of Pre-COPD in middle-aged Japanese adults","authors":"Yoko Shibata","doi":"10.1016/j.resinv.2025.07.006","DOIUrl":"10.1016/j.resinv.2025.07.006","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 885-886"},"PeriodicalIF":2.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A collaborative study to disseminate the clinical practice of diagnosing and managing Birt–Hogg–Dubé syndrome in Japan","authors":"Yukiko Namba ,&nbsp;Atsushi Yamashita ,&nbsp;Etsuko Kobayashi ,&nbsp;Takuo Hayashi ,&nbsp;Chikako Iwabuchi ,&nbsp;Akira Ishiko ,&nbsp;Satsuki Kishikawa ,&nbsp;Kenji Tsuboshima ,&nbsp;Masatoshi Kurihara ,&nbsp;Kazuhisa Takahashi ,&nbsp;Kuniaki Seyama","doi":"10.1016/j.resinv.2025.06.021","DOIUrl":"10.1016/j.resinv.2025.06.021","url":null,"abstract":"<div><h3>Background</h3><div>Birt–Hogg–Dubé syndrome (BHDS) is a rare autosomal dominant disorder caused by germline pathogenic variants in the folliculin (<em>FLCN)</em> gene and characterized by multiple pulmonary cysts, pneumothorax, fibrofolliculoma and/or trichodiscoma, and renal tumors. However, frontline physicians who manage lung manifestations have limited clinical experience with BHDS because of its rarity. Therefore, we initiated a collaborative study to assist physicians with limited BHDS diagnostic and management experience.</div></div><div><h3>Methods</h3><div>We conducted this study to support a series of diagnostic procedures for BHDS by frequently communicating with referral doctors. We expect that the successful clinical experience gained through this collaborative study will confer positive confidence on doctors to manage BHDS.</div></div><div><h3>Results</h3><div>Thirty-three hospitals and 155 patients were included in this study. Of the 155 patients, 138 were diagnosed with BHDS using two diagnostic criteria: the results of the skin biopsy and <em>FLCN</em> genetic test. <em>FLCN</em> genetic test revealed 41 unique variants, including 38 pathogenic, two likely pathogenic variants, and one variant of uncertain significance. We performed skin biopsy on 66 patients with BHDS; in 16 patients (22.9 %), both central and participant diagnoses were concordant as FF/TD, whereas 13 patients (18.6 %) had false positives (FF/TD by participant and not by central diagnosis), and 1 patient (1.4 %) had a false negative (FF/TD by central and not by participant diagnosis). A questionnaire survey revealed increased confidence in majority of participants who would see suspected patients with BHDS. However, there were some uncertainties regarding the characteristics of skin papules and genetic issues related to <em>FLCN</em> genetic test.</div></div><div><h3>Conclusions</h3><div>Our study contributes to the successful clinical expertise in the diagnosis and management of BHDS, indicating that hands-on support from experienced institutions can serve as a management model for other rare diseases.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 877-884"},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extranodal natural killer/T-cell lymphoma with lung involvement in a young adult with suspected mosquito bite hypersensitivity: A case report","authors":"Mariko Higa ,&nbsp;Eriko Atsumi ,&nbsp;Hironobu Hoshino ,&nbsp;Mahito Yamashiro ,&nbsp;Tomo Nakajima ,&nbsp;Mariko Tomita ,&nbsp;Hiroaki Masuzaki ,&nbsp;Naoki Wada ,&nbsp;Isoko Owan","doi":"10.1016/j.resinv.2025.07.002","DOIUrl":"10.1016/j.resinv.2025.07.002","url":null,"abstract":"<div><div>A young adult with suspected pulmonary lymphoma was diagnosed with extranodal natural killer/T-cell lymphoma (ENKTL). The patient had a history of possible mosquito bite hypersensitivity (MBH), suggesting a potential association between MBH and ENKTL. Although ENKTL typically affects middle-aged adults, it has rarely been reported in children with MBH or chronic active Epstein-Barr virus (EBV) disease. This case highlights the challenges of obtaining pathological confirmation from small biopsy samples of pulmonary ENKTL. Detailed history taking and EBV DNA testing may aid in diagnosis, particularly in younger patients.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 872-876"},"PeriodicalIF":2.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with pulmonary function decline in patients with rheumatoid arthritis-associated interstitial lung disease","authors":"Takako Kawaguchi ,&nbsp;Masahiro Tahara ,&nbsp;Kei Yamasaki ,&nbsp;Natsumi Tani ,&nbsp;Yurie Kanda-Satoh ,&nbsp;Takatoshi Aoki ,&nbsp;Yoshiya Tanaka ,&nbsp;Kazuhiro Yatera","doi":"10.1016/j.resinv.2025.06.017","DOIUrl":"10.1016/j.resinv.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Antifibrotic drugs have recently been recommended for patients with interstitial lung disease with progressive pulmonary function decline. However, the clinical characteristics of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) with progressive pulmonary function decline, including the relationship with RA disease activity, are unclear.</div></div><div><h3>Methods</h3><div>This retrospective study included patients diagnosed with RA-ILD at our hospital from 2011 to 2019 for whom data on pulmonary function tests (PFTs) and chest high-resolution computed tomography (HRCT) were available. Factors associated with a percent forced vital capacity (%FVC) absolute decline were determined using multivariate regression analysis, and a scoring system based on the results of the multivariate logistic regression analysis was developed to identify patients with progressive RA-ILD with an absolute decline in %FVC of ≥5 %.</div></div><div><h3>Results</h3><div>A total of 92 patients were enrolled, and the multivariate regression analysis showed that older-age (β, −0.27; 95 % confidence interval [CI], −0.49 to −0.05), worse Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) (β, −1.52; 95 % CI, −2.61 to −0.42), and HRCT modified-fibrosis score (FS) increase (β, −0.39; 95 % CI, −0.53 to −0.25) were negatively correlated with %FVC absolute change. The new scoring system to identify the progressive-RA-ILD patients based on five factors (advanced-age, male, increasing modified-FS, increasing ground-glass opacities, and worsening DAS28-ESR) showed an area under the curve of 0.830 (95 % CI, 0.731–0.929).</div></div><div><h3>Conclusions</h3><div>The scoring system combining five factors may be useful in estimating progressive-RA-ILD patients without conducting PFTs and help clinicians reconsider appropriate treatments with antifibrotic drugs and/or immunosuppressive therapies to control RA disease activity and suppress progressive pulmonary function decline.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 857-865"},"PeriodicalIF":2.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective investigation of the Controlling Nutritional Status (CONUT) score and clinical course of patients with COPD","authors":"Yukihiro Minegishi,&nbsp;Kento Sato,&nbsp;Yuto Takamura,&nbsp;Yumiri Suzuki,&nbsp;Yusuke Agatsuma,&nbsp;Sachie Nawa,&nbsp;Hiroki Ota,&nbsp;Kodai Furuyama,&nbsp;Maki Kobayashi,&nbsp;Hiroshi Nakano,&nbsp;Takako Nemoto,&nbsp;Michiko Nishiwaki,&nbsp;Akira Igarashi,&nbsp;Masafumi Watanabe,&nbsp;Sumito Inoue","doi":"10.1016/j.resinv.2025.06.020","DOIUrl":"10.1016/j.resinv.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>The Controlling Nutritional Status (CONUT) score evaluates nutritional status based on the following three indices: serum albumin, total cholesterol, and peripheral blood lymphocyte count. However, the impact of the CONUT score on the clinical course of patients with chronic obstructive pulmonary disease (COPD) has not been fully investigated.</div></div><div><h3>Methods</h3><div>We conducted an observational study of patients with stable COPD attending our hospital. At enrollment, patients with CONUT scores of ≤1 and ≥ 2 were assigned to the normal and malnourished groups, respectively. The patients’ clinical course for up to 5 years were prospectively analyzed.</div></div><div><h3>Results</h3><div>We enrolled 210 COPD patients (mean age: 70.5 years, 196 men). Seventy-two patients (34.3 %) had malnutrition with a CONUT score of ≥2. These patients were significantly older, had a lower body mass index (BMI), and had lower levels of pulmonary function than those with a normal CONUT score. There were no significant differences between the two groups in sex, smoking history, previous exacerbations, asthma and COPD overlap (ACO) status, COPD Assessment Test score, or emphysema severity at enrollment. The malnourished group had significantly more COPD exacerbations during the observation period than the normal group. After adjusting for age, BMI, ACO status, COPD severity, and emphysema severity by multivariate logistic regression analysis, the presence of malnutrition with a CONUT score of ≥2 was an independent risk factor for COPD exacerbation.</div></div><div><h3>Conclusion</h3><div>The assessment of nutritional status by using the CONUT score may be useful in assessing the risk of exacerbation in patients with stable COPD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 866-871"},"PeriodicalIF":2.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of right upper lobe lesion using the SUKEDACHI balloon with thin-bronchoscope to facilitate close-to-lesion transbronchial biopsy: Novel bronchoscopic technique","authors":"Yuki Takigawa ,&nbsp;Ken Sato ,&nbsp;Kotaro Miyake ,&nbsp;Suzuka Matsuoka ,&nbsp;Shoichiro Matsumoto ,&nbsp;Takeru Ichikawa ,&nbsp;Jun Nishimura ,&nbsp;Hiromi Watanabe ,&nbsp;Kenichiro Kudo ,&nbsp;Keiichi Fujiwara","doi":"10.1016/j.resinv.2025.07.003","DOIUrl":"10.1016/j.resinv.2025.07.003","url":null,"abstract":"<div><div>We report the first clinical use of a single-use bronchial dilatation catheter (SUKEDACHI) with a thin bronchoscope to diagnose a peripheral upper lobe lung lesion. In a man in his 70s, a part-solid nodule in the right upper lobe was difficult to reach using standard techniques. Balloon-assisted bronchial dilatation enabled advancement of the bronchoscope close to the lesion, allowing biopsy with standard forceps. Histopathology confirmed lung adenocarcinoma. This case highlights the potential of new technique to facilitate close-to-the-lesion access and improve diagnostic yield for peripheral pulmonary lesions.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 853-856"},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interleukin-32–expressing CD4+ T cells are a potentially pathogenic subset in systemic sclerosis with interstitial lung disease","authors":"Sho Ishigaki,&nbsp;Katsuya Suzuki,&nbsp;Yuko Kaneko","doi":"10.1016/j.resinv.2025.06.008","DOIUrl":"10.1016/j.resinv.2025.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, fibrosis, and inflammation. CD4⁺ T cells produce cytokines that are crucial in the pathogenesis of SSc. However, the role of CD4⁺ T cells in SSc-associated interstitial lung disease (SSc-ILD) remain unclear. Therefore, we aimed to characterize abnormal cytokine production by CD4⁺ T cell subsets in SSc-ILD.</div></div><div><h3>Methods</h3><div>We re-analysed publicly available single-cell (sc) RNA-seq datasets (13 SSc and 11 healthy control (HC) lung biopsy samples), bulk RNA-seq (HC peripheral blood (PB)), and microarray datasets from the PB of patients with 18 SSc-ILD and 16 HC) using R, RaNA-seq pipeline, and GEO2R web tool. CD4⁺ T cells were purified from the PB of HC and analysed.</div></div><div><h3>Results</h3><div>scRNA-seq data revealed higher <em>IL32</em> gene expression in CD4⁺ T cells from SSc lung biopsies compared to those from HC. Microarray data showed significantly higher <em>IL32</em> gene expression in CD4⁺ T cells from the PB of patients with SSc-ILD than in HC. <em>IL32</em> gene expression was elevated in Th1, Th2, and Th17 cells compared with naïve CD4⁺ T cells, and in central and effector memory CD4⁺ T cells compared with Tn. Furthermore, scRNA-seq data showed that <em>IL32</em> gene expression increased in Tn cells without stimulation and in memory CD4⁺ T cells stimulated with anti-CD3/28 antibodies.</div></div><div><h3>Conclusion</h3><div>Our results suggest that IL32-expressing CD4⁺ T cells are a key subset involved in SSc pathologies. IL-32 has both proinflammatory and anti-inflammatory effects on various cells; however, further studies are needed to explore its therapeutic potential.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 829-837"},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seventeen-year cumulative incidence of airflow limitation and lung function decline in two independent cohorts: The Japanese Red Cross Kumamoto study","authors":"Yuki Sato ,&nbsp;Ayumi Onoue ,&nbsp;Kentaro Machida ,&nbsp;Hiromasa Inoue ,&nbsp;Kenichi Kubota ,&nbsp;Minoru Yoshida ,&nbsp;Shinsuke Tsumura ,&nbsp;Takuya Kitagawa ,&nbsp;Kyohei Harada ,&nbsp;Yuichi Matsuo ,&nbsp;Kazuhiko Watanabe ,&nbsp;Kazuaki Kawai ,&nbsp;Hiroshi Yamato ,&nbsp;Hisamitsu Omori","doi":"10.1016/j.resinv.2025.06.019","DOIUrl":"10.1016/j.resinv.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated trends in the cumulative incidence of airflow limitation (AFL) and lung function decline over 17 years in two independent cohorts. Furthermore, this study focused on the possible effects of legal restrictions that came into effect in 2006 to prevent unwanted exposure to passive smoke on lung function decline in Japan.</div></div><div><h3>Methods</h3><div>Cohort 1 (1994–2011) and Cohort 2 (2002–2019) included 590 and 1012 participants, respectively. All participants were free of AFL at baseline, and they had no personal relationships each other. The association between the longitudinal category of smoking status and the cumulative incidence of AFL was assessed using logistic regression analysis. The annual FEV₁ decline was compared between Cohort 1 and 2, as well as before 2006 (pre) and after 2006 (post) within both cohorts.</div></div><div><h3>Results</h3><div>After adjusting for confounding factors, the odds ratio (OR) for developing AFL increased with smoking status and intensity in both Cohort 1 and 2. The annual FEV₁ decline in Cohort 2 was significantly slower than that in Cohort 1 for persistent never smokers. The annual decline in FEV₁ after 2006 (post) was significantly slower than that before 2006 (pre) in persistent never smokers in both Cohort 1 and 2.</div></div><div><h3>Conclusions</h3><div>Smoking remains a strong risk factor for the development of AFL and lung function decline in Japan. This study suggests that changes in the smoking environment may have preventative effects on lung function decline, especially in never smokers.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 844-852"},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and clinical significance of acute exacerbation of interstitial lung disease in patients with primary Sjögren's syndrome","authors":"Tomoyuki Fujisawa ,&nbsp;Yuko Tanaka ,&nbsp;Yosuke Kamiya ,&nbsp;Masato Kono ,&nbsp;Shinpei Kato ,&nbsp;Norimichi Akiyama ,&nbsp;Keigo Koda ,&nbsp;Sayomi Matsushima ,&nbsp;Hiromitsu Sumikawa ,&nbsp;Takeshi Johkoh ,&nbsp;Yusuke Inoue ,&nbsp;Hideki Yasui ,&nbsp;Hironao Hozumi ,&nbsp;Yuzo Suzuki ,&nbsp;Masato Karayama ,&nbsp;Kazuki Furuhashi ,&nbsp;Noriyuki Enomoto ,&nbsp;Naoki Inui ,&nbsp;Takafumi Suda","doi":"10.1016/j.resinv.2025.07.001","DOIUrl":"10.1016/j.resinv.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Acute exacerbation (AE) is defined as acute deterioration in the respiratory status that can lead to a fatal outcome. It may occur in various types of interstitial lung disease (ILD). However, its incidence and clinical picture in patients with primary Sjögren's syndrome-associated interstitial lung disease (pSjS-ILD) remain unclear. Therefore, this study aimed to examine the incidence and clinical significance of AE in patients with pSjS-ILD.</div></div><div><h3>Methods</h3><div>This study included 101 consecutive patients with pSjS-ILD. The clinical findings at diagnosis, AE development, and outcome were analyzed. Furthermore, the prognostic significance of AE was evaluated via Cox proportional-hazards analysis with time-dependent covariates. The Fine–Gray subdistribution hazard model was employed to identify factors associated with AE development.</div></div><div><h3>Results</h3><div>Of the 101 patients, 17 (17 %) developed AE during their clinical course. The cumulative incidence rates of AE were 2.0 %, 11.2 %, and 18.1 % at 1, 5, and 10 years, respectively. Multivariate analysis revealed that AE development was significantly associated with poor prognosis (hazard ratio: 3.69; <em>P</em> = 0.01) as well as age, male sex, and %FVC. Moreover, the serum levels of surfactant protein-D at diagnosis were significantly associated with AE development. Of the 17 patients demonstrating AE, 8 died, with a 60-day post-AE mortality rate of 47 %. The age and serum C-reactive protein level at AE onset were significantly associated with 60-day mortality in patients with AE of pSjS-ILD.</div></div><div><h3>Conclusion</h3><div>AE occurs with a certain frequency and is strongly associated with poor outcome in patients with pSjS-ILD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 838-843"},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The JRS guideline for the management of pneumonia in adults 2024","authors":"Hiroshi Mukae ,&nbsp;Naoki Iwanaga ,&nbsp;Nobuyuki Horita ,&nbsp;Kosaku Komiya ,&nbsp;Takaya Maruyama ,&nbsp;Yuichiro Shindo ,&nbsp;Yoshifumi Imamura ,&nbsp;Kazuhiro Yatera ,&nbsp;Yoshihiro Yamamoto ,&nbsp;Katsunori Yanagihara ,&nbsp;Nobuaki Shime ,&nbsp;Kazuyoshi Senda ,&nbsp;Hiroshi Takahashi ,&nbsp;Futoshi Higa ,&nbsp;Tetsuya Matsumoto ,&nbsp;Makoto Miki ,&nbsp;Shinji Teramoto ,&nbsp;Hiroki Tsukada ,&nbsp;Masahiro Yoshida ,&nbsp;Naoyuki Miyashita","doi":"10.1016/j.resinv.2025.06.014","DOIUrl":"10.1016/j.resinv.2025.06.014","url":null,"abstract":"<div><div>The Japanese Respiratory Society published the Adult Pneumonia Practice Guidelines 2024 in April 2024. In Japan, a super-aged society, the disease burden of pneumonia is significant and is expected to grow in the future. Given this historical context, the most important themes in this revision of the guidelines include the appropriate use of antibiotics and measures against pneumonia in older adults. A large portion of these cases involves aspiration pneumonia, making it challenging to achieve fundamental improvement with antibiotic treatment alone and necessitating a comprehensive approach. Preventing pneumonia and maintaining physical function are essential points for improving the prognosis of pneumonia in older adults, with an emphasis on promoting vaccination, rehabilitation, and oral care.</div><div>The treatment of Nursing and Healthcare-Associated Pneumonia (NHCAP), a Japan-specific category adapted from the ATS/IDSA's HCAP guidelines, has been extensively reviewed. Despite international moves away from HCAP due to concerns about the overuse of broad-spectrum antibiotics, Japan has chosen to retain NHCAP for treating pneumonia in older adults while implementing stricter controls on antibiotic use to promote antimicrobial stewardship.</div><div>In cases of repeated aspiration pneumonia or in situations where the patient is in a terminal state of age-related decline or the final stage of comorbidities, all pneumonia patients are recommended to undergo a background assessment, occasionally prioritizing palliative care and respecting the patient's outlook on life. The importance of advanced care planning has also been highlighted to underscore the need for interdisciplinary collaboration with medical doctors and other healthcare professionals.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 811-828"},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}