Respiratory investigation最新文献

{"title":"N-acetylcysteine inhalation improved sputum rheology in chronic productive cough: Clinical application in two cases.","authors":"Haruhiko Ogawa, Yuka Uchida, Lydia Esteban Enjuto","doi":"10.1016/j.resinv.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.resinv.2025.08.009","url":null,"abstract":"<p><p>This pilot study evaluated the effects of inhaled N-acetylcysteine (NAC) on sputum rheology in patients with chronic productive cough (CPC). Rheological measurements before and 30 min after inhalation were compared retrospectively in 16 outpatients receiving either NAC (n = 9) or bromhexine hydrochloride (BXH) (n = 7). NAC inhalation significantly reduced critical strain (γ_C), an indicator of sputum stringiness, from 2370 [1310-4390] % to 643 [389-700] % (median and interquartile range), with a significantly greater effect than BXH. This reduction was observed regardless of airway fungal colonization. In addition, two case reports, a 67-year-old man with bronchorrhea and a 79-year-old woman with refractory asthma, demonstrated improved quality-of-life scores evaluated with the Cough and Sputum Assessment Questionnaire (CASA-Q) and rheological improvement following 1-2 weeks of twice-daily NAC inhalation. These findings suggest that nebulized NAC may be a promising add-on therapy for refractory airway diseases characterized by high sputum stringiness (γ_C).</p>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"1246-1249"},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258964","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":"Biallelic c.2709del and c.3020T>G cause DNAH11-related primary ciliary dyskinesia presenting with Kartagener syndrome: Possible novel phenotype of diffuse-twisting wave-like movements of airway epithelial cell populations.","authors":"Akira Umeda, Hidenori Kiyosawa, Kazuya Miyagawa, Yoshiyuki Ohira, Masataka Higuchi, Ho Namkoong, Takanori Asakura, Makoto Ishii, Naoki Hasegawa, Koichi Fukunaga","doi":"10.1016/j.resinv.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.resinv.2025.09.023","url":null,"abstract":"<p><p>Primary ciliary dyskinesia (PCD) is a rare genetic disorder with ciliary dysfunction. The triad of situs inversus, chronic sinusitis, and bronchiectasis is termed Kartagener syndrome. We report a PCD patient presenting with Kartagener syndrome with a novel combination of DNAH11 alleles, i.e., a frameshift variant, c.2709del p.(Trp904Glyfs∗5), and a nonsense variant, c.3020T>G p.(Leu1007∗). The biallelic pathogenic variants were both rare and located close to the N-terminus. High-speed video microscopy revealed discordant cilia and diffuse-twisting wave-like movements of the airway epithelial cell populations. Researchers should note this phenomenon, and further investigation is necessary to clarify the role of DNAH11 in PCD.</p>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"1243-1245"},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258897","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":"Survival and functional outcomes of single lung transplantation in secondary pulmonary hypertension.","authors":"Dai Shimizu, Kentaroh Miyoshi, Haruchika Yamamoto, Shin Tanaka, Seiichiro Sugimoto, Mikio Okazaki, Shinichi Toyooka","doi":"10.1016/j.resinv.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.resinv.2025.09.022","url":null,"abstract":"<p><strong>Background: </strong>The role of single lung transplantation (SLT) in secondary pulmonary hypertension (SPH) remains controversial. This study evaluated the feasibility and long-term outcomes of SLT in patients with SPH-defined as mean pulmonary artery pressure ≥25 mmHg measured by right heart catheterization immediately before transplantation-within Japan's allocation system, characterized by protracted waiting periods.</p><p><strong>Methods: </strong>We retrospectively reviewed 83 deceased-donor lung transplantations, categorized into four groups: SLT without SPH (n = 14), SLT with SPH (n = 19), bilateral lung transplantation (BLT) without SPH (n = 12), and BLT with SPH (n = 38). Outcomes analyzed included 5-year survival, CLAD-free survival, and exercise tolerance.</p><p><strong>Results: </strong>At transplantation, 68.6 % of recipients exhibited SPH, a significant increase compared to registration. Among SLT recipients, the SPH group demonstrated 5-year survival (83.2 %) and CLAD-free survival (65.9 %) not inferior to those of the non-SPH group (50.0 % and 56.8 %, respectively). Perfusion ratios and 6-min walk distances remained comparable between SPH and non-SPH groups for up to five years. Additionally, 5-year survival (83.2 % vs. 81.1 %) and CLAD-free survival (65.9 % vs. 64.5 %) were similar between SLT and BLT. High preoperative oxygen requirements were associated with poorer early graft function in SPH patients receiving SLT. No definitive predictors of CLAD or long-term survival were identified.</p><p><strong>Conclusions: </strong>SLT is a viable option for patients with mild-to-moderate SPH, providing survival and functional outcomes comparable to BLT. Careful recipient and donor selection remains essential, particularly given the risk of SPH progression during extended waiting periods.</p>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"1235-1242"},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252501","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":"Prognostic comparison of acute exacerbations across idiopathic interstitial pneumonia subtypes: A nationwide observational study.","authors":"Nobuyasu Awano, Shotaro Aso, Takehiro Izumo, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1016/j.resinv.2025.10.001","DOIUrl":"https://doi.org/10.1016/j.resinv.2025.10.001","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of idiopathic interstitial pneumonias (AE-IIPs) are life-threatening events. However, comparative prognostic data across IIP subtypes during AE are limited. This study aimed to evaluate in-hospital mortality differences among major AE-IIP subtypes using a nationwide database in Japan.</p><p><strong>Methods: </strong>We retrospectively analysed patients with AE of idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organising pneumonia (COP), or acute interstitial pneumonia (AIP) who received high-dose methylprednisolone between 1 July, 2010 and 31 March, 2023. Data were extracted from the Japanese Diagnosis Procedure Combination database. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included 14- and 28-day mortality. Multivariable logistic regression analysis with generalised estimating equations was employed to adjust for potential confounders, incorporating multiple imputation to address missing data.</p><p><strong>Results: </strong>A total of 6645 patients were included (IPF, n = 2092; NSIP, n = 581; COP, n = 871; AIP, n = 3101). Unadjusted in-hospital mortality rates were 53.9 % for IPF, 40.1 % for NSIP, 17.6 % for COP, and 49.3 % for AIP. After adjustment, in-hospital mortality was significantly higher for IPF (odds ratio [OR], 3.92; 95 % confidence interval [95 % CI], 3.05-5.04; p < 0.001), NSIP (OR, 2.80; 95 % CI, 2.10-3.73; p < 0.001), and AIP (OR, 3.07; 95 % CI, 2.43-3.89; p < 0.001), compared with COP. Similar trends were observed for both secondary outcomes.</p><p><strong>Conclusions: </strong>Among patients with AE-IIPs, those with IPF, NSIP, and AIP exhibited significantly higher in-hospital mortality compared with COP. These findings underscore the inferior prognosis associated with AE-IPF and AIP.</p>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"1229-1234"},"PeriodicalIF":2.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244941","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 LIAISON® Legionella Urinary Ag assay: A novel high-throughput, fully automated dual-antigen detection method with improved sensitivity and expanded Legionella species and serogroup coverage","authors":"Serena Ferraiuolo ,&nbsp;Farah Bou Nasser Eddine ,&nbsp;Deborah Ferrante ,&nbsp;Andrea Dal Corso ,&nbsp;Lorenzo Querin ,&nbsp;Marco Rigamonti ,&nbsp;PierNatale Brusasca ,&nbsp;Alfredo Mento ,&nbsp;Antonio Savinelli ,&nbsp;Karolina Zytko ,&nbsp;Massimo Panizzo ,&nbsp;Elisa Ghezzi ,&nbsp;Clara Rossini ,&nbsp;Chiara Mauro ,&nbsp;Andrea Pighini ,&nbsp;Claudia Zierold ,&nbsp;Fabrizio Bonelli ,&nbsp;Paolo Ingallinella","doi":"10.1016/j.resinv.2025.09.006","DOIUrl":"10.1016/j.resinv.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div><em>Legionella pneumophila</em> is a leading cause of Legionnaires’ disease, with <em>Legionella pneumophila</em> serogroup 1 (<em>Lp</em>1) being the most commonly detected strain. Current urinary antigen tests (UAT) primarily target <em>Lp</em>1, leading to underdiagnosis of non-<em>Lp</em>1 and other <em>Legionella</em> species. A broad-spectrum, fully automated UAT is needed to improve diagnostic accuracy and patient outcomes.</div></div><div><h3>Methods</h3><div>A novel chemiluminescence immunoassay-based UAT was developed targeting both <em>Legionella</em> peptidoglycan-associated lipoprotein (PAL) and soluble lipopolysaccharide antigen to enable broader detection. Monoclonal antibodies were generated against PAL and integrated into an automated immunoassay platform. The assay's analytical performance was evaluated using recombinant PAL antigens, urine samples spiked with <em>Legionella</em> strains, and clinical specimens. Sensitivity, specificity, cross-reactivity, interference, and precision were assessed.</div></div><div><h3>Results</h3><div>The LIAISON® <em>Legionella</em> Urinary Ag assay demonstrated a 97.5 % positive agreement and 100 % negative agreement with the Binax™ UAT in detecting <em>Legionella</em> infections. Importantly, the new test also identified multiple non-<em>Lp</em>1 <em>Legionella</em> species, which the comparator assay failed to detect. The assay showed low imprecision, no cross-reactivity or interference.</div></div><div><h3>Conclusions</h3><div>The LIAISON® <em>Legionella</em> Urinary Ag Assay, a fully automated chemiluminescence-based UAT, provides highly sensitive and specific detection of <em>Legionella</em> infections, including non-<em>Lp</em>1 strains, addressing a major limitation of existing diagnostics. This assay has the potential to improve early detection, guide targeted antibiotic therapy, and enhance public health surveillance of Legionnaires’ disease.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1221-1228"},"PeriodicalIF":2.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219745","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":"Extent of pulmonary involvement on admission predicts long-term pulmonary and muscular sequelae of COVID-19: A longitudinal computed tomography study","authors":"Takashi Shimada ,&nbsp;Naoya Tanabe ,&nbsp;Shotaro Chubachi ,&nbsp;Takanori Asakura ,&nbsp;Ho Namkoong ,&nbsp;Hiromu Tanaka ,&nbsp;Shuhei Azekawa ,&nbsp;Shiro Otake ,&nbsp;Kensuke Nakagawara ,&nbsp;Takahiro Fukushima ,&nbsp;Mayuko Watase ,&nbsp;Tomoki Maetani ,&nbsp;Yusuke Shiraishi ,&nbsp;Hideki Terai ,&nbsp;Mamoru Sasaki ,&nbsp;Soichiro Ueda ,&nbsp;Yukari Kato ,&nbsp;Norihiro Harada ,&nbsp;Shoji Suzuki ,&nbsp;Shuichi Yoshida ,&nbsp;Koichi Fukunaga","doi":"10.1016/j.resinv.2025.09.014","DOIUrl":"10.1016/j.resinv.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Studies on the association between chest computed tomography (CT) findings of extensive pulmonary involvement and long-term pulmonary and extrapulmonary coronavirus disease 2019 (COVID-19) sequelae are lacking. This study aimed to investigate the relationship between the severity of pneumonia on admission and residual pulmonary and extrapulmonary complications at three months post-hospitalization.</div></div><div><h3>Methods</h3><div>Using data from the Japan COVID-19 Task Force database, we conducted quantitative analysis of CT scans of 164 patients obtained at admission and three months later. The parameters included pneumonia volume, total lung volume, and area and density of the pectoralis muscle (PM), subcutaneous and epicardial adipose tissue, and vertebral bone density.</div></div><div><h3>Results</h3><div>Patients with extensive pneumonia on admission had high residual pneumonia volumes, reduced lung volumes, and decreased area and density of PM at three months. No significant differences were observed in the adipose tissue or bone parameters. The severity of pneumonia at admission was independently associated with PM atrophy.</div></div><div><h3>Conclusions</h3><div>CT-based quantification of pneumonia extent during the acute phase of COVID-19 may be useful in predicting long-term pulmonary sequelae and muscle wasting. This approach may allow the objective evaluation of Long COVID and facilitate the identification of potential therapeutic targets.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1215-1220"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207264","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":"Differences between influenza and COVID-19 patients who required hospitalization: A study of the 2024–2025 season","authors":"Naoyuki Miyashita ,&nbsp;Yasushi Nakamori ,&nbsp;Makoto Ogata ,&nbsp;Naoki Fukuda ,&nbsp;Akihisa Yamura ,&nbsp;Tomoki Ito","doi":"10.1016/j.resinv.2025.09.012","DOIUrl":"10.1016/j.resinv.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>During the winter and spring of 2024–2025, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) XEC subvariant became the main cause of the epidemic, and at the same time, major influenza epidemics were also observed. To clarify the differences between COVID-19 and influenza, we conducted a comparative study of patients who required hospitalization during the same period.</div></div><div><h3>Methods</h3><div>We compared 193 patients with COVID-19 Omicron XEC subvariant and 98 patients with influenza H1N1 pdm09 who required hospitalization.</div></div><div><h3>Results</h3><div>The following characteristics were significantly more common in the COVID-19 group than in the influenza group: 1) males, 2) patients with chronic kidney disease, malignant tumors, autoimmune diseases, and patients using immunosuppressants, 3) patients with multiple underlying diseases, 4) healthcare-associated pneumonia, 5) pure viral pneumonia, 6) aspiration pneumonia, 7) cases in which antivirals had not been used since the diagnosis of infection, 8) patients who required invasive mechanical ventilation management or intensive care unit admission, and 9) deaths. On the other hand, the following characteristics were significantly more frequently observed in the influenza group than in the COVID-19 group: 1) patients without underlying diseases, 2) patients who had been vaccinated within the past year, 3) community-acquired pneumonia, and 4) mixed bacterial pneumonia.</div></div><div><h3>Conclusions</h3><div>There were many differences between the COVID-19 group and the influenza group that required hospitalization. The rates of severe illness and mortality in the elderly remain high in the COVID-19 group.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1210-1214"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207297","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":"Nutritional assessments as predictors of prognosis after long-term oxygen therapy in patients with idiopathic pulmonary fibrosis","authors":"Mayuko Ishiwari,&nbsp;Yuta Kono,&nbsp;Yuki Togashi,&nbsp;Kenichi Kobayashi,&nbsp;Ryota Kikuchi,&nbsp;Mariko Kogami,&nbsp;Shinji Abe","doi":"10.1016/j.resinv.2025.09.019","DOIUrl":"10.1016/j.resinv.2025.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic pulmonary fibrosis (IPF), a chronic and progressive interstitial lung disease, frequently leads to chronic respiratory failure, necessitating long-term oxygen therapy (LTOT). Although the prognosis of patients with IPF receiving LTOT is generally poor, limited data are available on clinical factors associated with post-LTOT survival. This study aimed to investigate whether baseline nutritional status at the time of initiation of LTOT is associated with survival outcomes in patients with IPF.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 55 patients with IPF and chronic respiratory failure who initiated LTOT. Patients were stratified into two groups based on 1-year survival following LTOT initiation: long-term survivors (≥1 year) and short-term survivors (&lt;1 year). Nutritional status at baseline was assessed using the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), body mass index (BMI), and fat-free mass index (FFMI).</div></div><div><h3>Results</h3><div>Significant differences were identified between the two groups in BMI, GNRI scores, and the proportion of patients receiving antifibrotic agents. In multivariable analyses adjusted for age, sex and the use of antifibrotic agents, both a GNRI score &lt;92 and a low FFMI were independently associated with increased mortality risk (p = 0.033 and p = 0.007, respectively). Kaplan–Meier analysis demonstrated significantly poorer 1-year survival in patients with GNRI &lt;92 and low FFMI (p = 0.037 and p = 0.006, respectively).</div></div><div><h3>Conclusion</h3><div>GNRI and FFMI independently predicted 1-year survival in IPF patients on LTOT. These findings underscore the importance of nutritional evaluation at LTOT initiation and suggest that low GNRI and FFMI warrant closer monitoring and targeted nutritional interventions.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1204-1209"},"PeriodicalIF":2.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157838","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 true history of COPD-bronchiectasis overlap syndrome","authors":"Grace Oscullo ,&nbsp;Miguel Angel Martinez-Garcia","doi":"10.1016/j.resinv.2025.09.021","DOIUrl":"10.1016/j.resinv.2025.09.021","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1201-1203"},"PeriodicalIF":2.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157837","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":"Impact of physical activity on respiratory disease: Current status and therapeutic implications","authors":"Kazuhisa Asai","doi":"10.1016/j.resinv.2025.09.020","DOIUrl":"10.1016/j.resinv.2025.09.020","url":null,"abstract":"<div><div>Regular physical activity (PA) modulates key pathophysiological mechanisms underlying the onset, progression, and symptoms of major respiratory diseases. Notably, low daily PA and high sedentary time independently predict faster lung function decline, poorer quality of life, and premature mortality in asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILDs), and post-coronavirus disease lung sequelae. Conversely, structured exercise training—and the increasingly popular, lifestyle-integrated “move-more–sit-less” programs—improve dyspnea, exercise capacity, airway and systemic inflammation, and healthcare utilization. Large cohort analyses corroborate a clear dose-response relationship: attaining ≥7500 steps/day or ≥150 min/week of moderate-to-vigorous activity yields the greatest clinical benefit, even in individuals with impaired pulmonary function. Mechanistic studies also revealed that exercise dampens type-2 airway inflammation in asthma, enhances the skeletal muscle oxidative phenotype in COPD, and counteracts ILD-related deconditioning. Recent randomized trials have shown that pulmonary rehabilitation can improve 5-year survival in fibrotic ILD, while telerehabilitation and gamified smartphone coaching can close access gaps without compromising efficacy. Additionally, major international guidelines such as the Global Initiative for Asthma 2024 and Global Initiative for Chronic Obstructive Lung Disease 2025 now explicitly recognize PA as a “treatable trait.” Nevertheless, PA uptake in routine care remains limited by behavioral, environmental, and policy barriers. Future work must refine personalized PA prescriptions, integrate wearable-derived metrics into decision-support algorithms, and test the synergistic effects with emerging biologics and anti-fibrotic agents. This review synthesizes contemporary evidence, highlights unanswered questions, and offers pragmatic recommendations for clinicians aiming to embed PA promotion in comprehensive respiratory care pathways.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1187-1193"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157839","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}