Respiratory investigation最新文献

{"title":"Risk factors for the onset of pneumothorax in idiopathic pulmonary fibrosis","authors":"Ryoju Sato,&nbsp;Machiko Arita,&nbsp;Hiroshi Takahashi,&nbsp;Akihiko Amano,&nbsp;Ayaka Tanaka,&nbsp;Masamitsu Hamakawa,&nbsp;Tadashi Ishida","doi":"10.1016/j.resinv.2025.06.007","DOIUrl":"10.1016/j.resinv.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Pneumothorax is a serious complication in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to clarify the clinical course of and risk factors for pneumothorax in patients with IPF.</div></div><div><h3>Methods</h3><div>This was a retrospective, cohort study of 164 patients with IPF diagnosed based on relevant guideline criteria. The clinical course of patients with pneumothorax was summarized, and risk factors for pneumothorax were assessed using Fine-Gray proportional hazards model analysis with time-dependent covariates.</div></div><div><h3>Results</h3><div>Of the 164 patients, 30 (18.3 %) developed pneumothorax. Of the 30 patients with pneumothorax, 4 (13.3 %) died in hospital, and the median duration of chest tube insertion was 11 (6–17.5) days. Low body mass index (BMI) and upper lobe pleuroparenchymal thickening on high-resolution computed tomography (HRCT) were significantly associated with pneumothorax onset (hazard ratio [HR] = 0.85 and 2.55; 95 % confidence interval [CI]: 0.73–0.98 and 1.14–5.73; <em>P</em> = 0.031 and 0.023, respectively). In patients who had repeat pulmonary function tests 6–18 months after diagnosis, annual reduction rates of forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) were significantly associated with pneumothorax onset (HR = 0.97 and 0.97; 95 % CI: 0.93–1.00 and 0.94–0.99; <em>P</em> = 0.034 and 0.013, respectively).</div></div><div><h3>Conclusion</h3><div>Pneumothorax is a serious event having a poor prognosis and requiring long-term treatment in patients with IPF. Low BMI, upper lobe pleuroparenchymal thickening on HRCT, annual FVC reduction rates, and annual DLCO reduction rates are associated with the onset of pneumothorax in patients with IPF.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 744-748"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321798","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":"Antifibrotic agents in progressive pulmonary fibrosis and non-progressive pulmonary fibrosis of fibrotic hypersensitivity pneumonitis","authors":"Taichi Kaneko ,&nbsp;Ryo Okuda ,&nbsp;Tamiko Takemura ,&nbsp;Tae Iwasawa ,&nbsp;Sanshiro Haga ,&nbsp;Yuriko Takeda ,&nbsp;Eri Hagiwara ,&nbsp;Takashi Ogura","doi":"10.1016/j.resinv.2025.06.004","DOIUrl":"10.1016/j.resinv.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>In patients with fibrotic hypersensitivity pneumonitis (HP), the effect of antifibrotic agents in those with progressive pulmonary fibrosis (PPF) and non-PPF remain unclear. This study aims to evaluate the effects of antifibrotic agents in patients with fibrotic HP by comparing outcomes between the PPF and non-PPF groups.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included patients diagnosed with pathologically confirmed fibrotic HP who received antifibrotic agents. Patients were classified as PPF or non-PPF based on disease progression in the year before antifibrotic treatment.</div></div><div><h3>Results</h3><div>In this study, 63 were classified as PPF and 33 as non-PPF. Overall survival differed significantly between the groups (hazard ratio [HR] = 3.28, 95 % confidence interval [CI]: 1.48–7.28, p = 0.002). The incidence of acute exacerbation was also higher in the PPF group (HR = 2.45, 95 % CI: 1.05–5.75, p = 0.033). In the PPF group, the annual forced vital capacity (FVC) decline improved from −11.5 % before treatment to −4.2 % in the first year after treatment (p &lt; 0.001). In the non-PPF group, the annual FVC change before and after treatment was not significantly different (1.6 % vs. −1.7 %, p = 0.065). Serum Krebs von den Lungen-6 (KL-6) levels decreased in the PPF group after 12 months of treatment (24.9 % vs. −2.7 %, p = 0.002), while no significant change was observed in the non-PPF group (8.6 % vs. 4.3 %, p = 0.800).</div></div><div><h3>Conclusions</h3><div>In fibrotic HP, antifibrotic agents seemed to contribute to a reduction in FVC decline and lower KL-6 levels in patients with PPF.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 737-743"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321796","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":"Safety of cryobiopsy for peripheral pulmonary lesions in older people","authors":"Mika Iwasaki ,&nbsp;Keigo Uchimura ,&nbsp;Hideaki Furuse ,&nbsp;Tatsuya Imabayashi ,&nbsp;Takaaki Tsuchida ,&nbsp;Yuji Matsumoto","doi":"10.1016/j.resinv.2025.06.009","DOIUrl":"10.1016/j.resinv.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Cryobiopsy enables bronchoscopists to perform high-quality, large, and entirely circumferential sampling and has been reported to improve the diagnostic yield of peripheral pulmonary lesions (PPLs) when combined with conventional bronchoscopic procedures. However, little is known regarding the safety of cryobiopsy for PPLs in older patients. Thus, we aimed to evaluate whether cryobiopsy is safe when performed on elderly patients with PPLs.</div></div><div><h3>Methods</h3><div>We reviewed consecutive patients who underwent cryobiopsy for PPLs using a 1.7-mm single-use cryoprobe at the National Cancer Center Hospital between June 2020 and December 2021. Patients’ characteristics, vital signs before and during the procedures, and complications were compared between the E (elderly patients, aged ≥75 years) and NE (non-elderly patients, aged &lt;75 years) groups.</div></div><div><h3>Results</h3><div>A total of 165 patients were analyzed, with 45 in the E group and 120 in the NE group. No significant difference was observed in the Charlson Comorbidity Index between the two groups. The E group had higher rates of hypertension (55.6 % vs. 33.3 %, <em>P</em> = 0.012), eastern cooperative oncology group-performance status of 1 (31.1 % vs. 13.3 %, <em>P</em> = 0.012), and antiplatelet or anticoagulant use (22.2 % vs. 6.7 %, <em>P</em> &lt; 0.01) than the NE group. There were no significant differences in the complication rates: bleeding, pneumothorax, pneumonia, and hypoxemia. Additionally, no significant difference was observed in vital sign changes during the procedures.</div></div><div><h3>Conclusions</h3><div>There were no significant differences in complication rates or changes in vital signs between the two groups. Therefore, cryobiopsy may be safe even for patients over 75 years of age.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 749-754"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321797","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":"Successful transbronchial cryobiopsy of a ground glass opacity predominant lesion assisted with a 3-dimensional mobile C-arm system under moderate sedation","authors":"Tadashi Sakaguchi,&nbsp;Yoichi Nishii,&nbsp;Osamu Hataji","doi":"10.1016/j.resinv.2025.06.006","DOIUrl":"10.1016/j.resinv.2025.06.006","url":null,"abstract":"<div><div>The usefulness of a 3-dimensional (3D) mobile C-arm system under moderate sedation is little known. A 76-year-old man was referred to our hospital due to a ground-glass opacity (GGO) predominant pulmonary nodule. No obvious changes in tumor exposure were observed in direct visualization using ultra-thin bronchoscopy under moderate sedation. We could confirm the tool-in-lesion using real-time 3D imaging using a 3D mobile C-arm system, and successfully diagnosed a papillary adenocarcinoma by a cryobiopsy. The 3D mobile C-arm system has the potential to provide valuable real-time guidance for transbronchial biopsies of GGO-predominant small lesions even under moderate sedation.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 734-736"},"PeriodicalIF":2.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279767","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":"Real-world effectiveness of budesonide/glycopyrronium/formoterol fumarate metered dose inhaler on symptoms and quality of life in patients with COPD: EBISU study","authors":"Shigeo Muro ,&nbsp;Soichiro Hozawa ,&nbsp;Hisatoshi Sugiura ,&nbsp;Yuri Yoshida ,&nbsp;Naoyuki Makita ,&nbsp;Yuki Kato ,&nbsp;Takehiro Hirai ,&nbsp;Kenichiro Nishida ,&nbsp;Tomotaka Kawayama","doi":"10.1016/j.resinv.2025.05.007","DOIUrl":"10.1016/j.resinv.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>There are limited real-world data regarding triple therapy with inhaled corticosteroid/long-acting muscarinic antagonist/long-acting β₂-agonist on symptoms and patient-reported outcomes (PROs) in patients with chronic obstructive pulmonary disease (COPD), without current/history of asthma. We investigated the effects of budesonide/glycopyrronium/formoterol fumarate (BGF) metered dose inhaler (MDI) triple therapy on health status and PROs in patients with COPD in daily clinical practice.</div></div><div><h3>Methods</h3><div>This was a 12-week, prospective, multicenter, observational study (NCT05219630). The primary endpoint was mean change from baseline in the COPD Assessment Test (CAT) over 12 weeks. Secondary and exploratory endpoints included mean change from baseline in the St George's Respiratory Questionnaire (SGRQ) over 12 weeks and CAT score subgroup analyses.</div></div><div><h3>Results</h3><div>In total, 102 patients were analyzed; mean age at baseline was 73.8 years, mean forced expiratory volume in 1 s was 57.7 %, CAT total score was 15.6, and SGRQ score was 33.3. The adjusted mean change from baseline over 12 weeks in CAT was −2.9 (standard error [SE] 0.5) (P &lt; 0.001), and in SGRQ was −2.7 (SE 0.9) (P = 0.004). As early as Week 4, these scores were significantly improved from baseline. In subgroup analyses, CAT scores were improved, regardless of blood eosinophil counts at baseline and exacerbation history in the previous year.</div></div><div><h3>Conclusions</h3><div>Triple therapy with a BGF MDI significantly improved CAT and SGRQ scores over 12 weeks. BGF MDI could be a suitable option for patients living with COPD who have persistent symptoms without current asthma or a history of asthma.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov (NCT05219630)</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 726-733"},"PeriodicalIF":2.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262793","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":"Rare-variant collapsing analyses of asthma in the UK biobank","authors":"Bengt Zöller ,&nbsp;Eric Manderstedt ,&nbsp;Christina Lind-Halldén ,&nbsp;Christer Halldén","doi":"10.1016/j.resinv.2025.05.016","DOIUrl":"10.1016/j.resinv.2025.05.016","url":null,"abstract":"<div><div>Asthma is a common health problem. Both common and rare genetic risk factors may contribute to asthma, but few large-scale whole-exome sequencing studies elucidating the contribution of rare variations to asthma have been published. Two published UK Biobank portals: the Genebass portal (N = 269,171) and the Astra Zeneca portal (N = 484,111) (<span><span>https://azphewas.com/</span><svg><path></path></svg></span>and <span><span>https://app.genebass.org/</span><svg><path></path></svg></span>) were used to access gene collapsing analysis of rare variations for asthma. A conservative threshold (p ≤ 2 × 10−9) was used to decrease the risk of spurious associations. Rare variations in two genes were significantly linked to asthma (<em>Il33</em>, <em>FLG</em>). Both genes have previously been linked to asthma in genome-wide association studies. The strongest non-significant gene was <em>CSF2RA</em> with a p-value of 6.09e-8. In conclusion, no novel significant asthma loci were identified using gene collapsing analyses. Future rare variant analysis studies of asthma need to refine phenotypic classification and incorporating diverse populations.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 723-725"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240762","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":"Duration and determinants of biologic initiation in the treatment of severe asthma","authors":"Tatsuya Imabayashi ,&nbsp;Toshiyuki Tanaka ,&nbsp;Kohei Yamamoto ,&nbsp;Kazuki Jinno ,&nbsp;Shunya Tanaka ,&nbsp;Sayaka Uda ,&nbsp;Tatsuya Yuba ,&nbsp;Chieko Takumi","doi":"10.1016/j.resinv.2025.06.003","DOIUrl":"10.1016/j.resinv.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Factors influencing biologic initiation in severe asthma remain unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated the duration and determinants of biologic initiation in 54 patients with severe asthma who were started on biologics at our hospital between 2018 and 2024.</div></div><div><h3>Results</h3><div>The median age was 74 years, and 72.2 % of the patients were biologic-naïve. Patients required a median of three explanations for biologic initiation, with 25.9 % requiring four or more. These patients had a higher prevalence of pre-prescribed oral corticosteroids (OCS) for anticipated exacerbations (58.3 % vs. 7.1 %, P &lt; 0.001) and more frequent exacerbations (median, 4 vs. 1; P = 0.004). Multivariate analysis identified pre-prescribed OCS as an independent factor requiring four or more explanations (adjusted odds ratio, 10.50; P = 0.008). Exacerbation was the primary determinant of initiation (64.8 %).</div></div><div><h3>Conclusions</h3><div>Pre-prescribed OCS and frequent exacerbations contributed to delays in biologic initiation. To facilitate timely initiation, habitual pre-prescribed OCS use without an action plan should be avoided.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 718-722"},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231020","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":"Clinical and complete remission in patients with severe asthma with 24-month dupilumab treatment","authors":"Tomoko Tajiri ,&nbsp;Motohiko Suzuki ,&nbsp;Hirono Nishiyama ,&nbsp;Tatsuro Suzuki ,&nbsp;Yuki Amakusa ,&nbsp;Keima Ito ,&nbsp;Yuta Mori ,&nbsp;Kensuke Fukumitsu ,&nbsp;Satoshi Fukuda ,&nbsp;Yoshihiro Kanemitsu ,&nbsp;Takehiro Uemura ,&nbsp;Hirotsugu Ohkubo ,&nbsp;Masaya Takemura ,&nbsp;Yutaka Ito ,&nbsp;Tetsuya Oguri ,&nbsp;Akio Niimi","doi":"10.1016/j.resinv.2025.06.002","DOIUrl":"10.1016/j.resinv.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>A few studies have reported asthma clinical remission with 24-month dupilumab therapy; however, complete remission remains unknown. In this post hoc analysis of our previous study, the achievement rates of clinical and complete remissions, and the factors associated with clinical remission with 24-month dupilumab therapy were assessed in adult patients with severe asthma.</div></div><div><h3>Methods</h3><div>Twenty-eight patients who had participated in our previous study were included. The primary outcome was the achievement rates of three-component clinical remission, four-component clinical remission, and complete remission at 24 months. The secondary outcome was the factors associated with achievement of four-component clinical remission at 24 months. Three-component or four-component clinical remission was defined as: 1) no significant asthma symptoms; 2) oral corticosteroid-free; 3) exacerbation-free; with or without 4) normalized pulmonary function. Complete remission was defined as four-component clinical remission plus 5) the resolution of asthma-related inflammation and 6) negative airway hyperresponsiveness.</div></div><div><h3>Results</h3><div>At 24 months, 19 (68 %), 16 (57 %), and 2 patients (7 %) achieved three-component, four-component clinical remission, and complete remission, respectively. At 24 months, patients with a higher incidence of comorbid chronic rhinosinusitis with nasal polyps, lower incidence of comorbid depression/anxiety, higher type 2 biomarkers, lower inhaled corticosteroid dose, better asthma control at baseline, and fewer exacerbations, unscheduled physicians’ visit or hospitalization in the previous year more frequently achieved four-component clinical remission than those without (all P &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>The achievement rates of clinical or complete remission were maintained for up to 24 months in patients with severe asthma receiving dupilumab therapy.</div></div><div><h3>Trial registration</h3><div>This study was registered in the UMIN Clinical Trial Registry (UMIN000038669)</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 5","pages":"Pages 711-717"},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221680","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":"Evaluation and management of rheumatoid arthritis-associated interstitial lung disease","authors":"Yuhei Ito ,&nbsp;Yoshiyuki Arinuma ,&nbsp;Ayako Nakajima","doi":"10.1016/j.resinv.2025.05.011","DOIUrl":"10.1016/j.resinv.2025.05.011","url":null,"abstract":"<div><div>Interstitial lung disease (ILD) is a significant extra-articular manifestation of rheumatoid arthritis (RA) that is associated with increased mortality risk and has a profound influence on treatment strategies. Early detection using advanced diagnostic tools, such as high-resolution computed tomography (HRCT), is crucial for evaluating RA-ILD and optimising patient outcomes. The traditional classification of RA-ILD into usual interstitial pneumonia and non-specific interstitial pneumonia patterns is challenging because RA-ILD exhibits features distinct from those of idiopathic interstitial pneumonia. Furthermore, the extent of ILD, as assessed using HRCT, has been increasingly recognised as a critical prognostic factor, emphasising its clinical relevance. As RA-ILD represents an organ-specific manifestation of a systemic inflammatory disease, its management should prioritise effective arthritis control. Growing evidence suggests that optimal arthritis control may mitigate the risk of RA-ILD development and progression. RA-ILD has often been diagnosed in advanced stages and managed using glucocorticoids (GCs) and immunosuppressive agents. However, increasing awareness of the toxicity associated with long-term use of GCs has prompted a shift toward the use of molecular-targeted therapies instead. Emerging data support the potential use of methotrexate in patients with RA and early-stage ILD, and the impact of molecular-targeting disease-modifying antirheumatic drugs on RA-ILD. Nintedanib, which has been shown to slow pulmonary function decline, should be considered in the appropriate stages of RA-ILD. As comprehensive follow-up strategies are essential for monitoring disease progression and guiding individualised treatment plans, effective management of RA-ILD requires multidisciplinary collaboration among rheumatologists, pulmonologists, and radiologists with continued research to improve RA-ILD outcomes.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 4","pages":"Pages 699-710"},"PeriodicalIF":2.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212930","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":"Innovative palliative approaches for terminal respiratory diseases: Exploring the effectiveness and pharmacokinetics of the blonanserin transdermal patch","authors":"Katsutoshi Ando ,&nbsp;Ayumi Suzuki ,&nbsp;Hiroki Yoshida","doi":"10.1016/j.resinv.2025.05.014","DOIUrl":"10.1016/j.resinv.2025.05.014","url":null,"abstract":"<div><h3>Background</h3><div>The blonanserin transdermal patch, the first antipsychotic patch approved in Japan for schizophrenia, was reported to reduce the prevalence of terminal delirium from 70.4 % to 16.3 % and manage refractory dyspnea in respiratory disease (Respir Invest 2023; 240–6). While parkinsonism and akathisia have been reported as adverse events in over 10 % of patients with schizophrenia, such side effects were rare in our terminally ill patient population. To further investigate its effectiveness in this patient population, we conducted a retrospective study with the additional aim of evaluating its pharmacokinetic profile.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the medical records of 150 terminally ill patients with respiratory diseases receiving home medical care and treated with the blonanserin transdermal patch. Plasma blonanserin levels were measured in 32 patients and compared with reconstructed clinical trial data using a normal distribution model.</div></div><div><h3>Results</h3><div>Twenty-eight patients (18.7 %) developed terminal delirium, which is consistent with our previous study findings. The treatment-emergent adverse events included extrapyramidal symptoms (5.3 %) and skin-related reactions (2.0 %). In previous clinical trials, plasma concentrations on days 7–8 following administration of the 40-mg blonanserin patch were reported as 0.70 ± 0.31 ng/mL, whereas in our study, the corresponding value was markedly lower at 0.29 ± 0.29 ng/mL. Additionally, statistical analysis confirmed that plasma concentrations in our population were significantly lower than those reported in clinical trial data (p = 0.022).</div></div><div><h3>Conclusion</h3><div>The blonanserin transdermal patch demonstrated therapeutic effectiveness and a favorable safety profile in terminally ill patients with respiratory diseases, despite reduced plasma concentrations.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 4","pages":"Pages 686-692"},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189386","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}