Respiratory investigation最新文献

{"title":"Safety of transbronchial lung cryobiopsy compared to transbronchial forceps biopsy in patients with diffuse lung disease: An observational study using a national database in Japan","authors":"Nobuyasu Awano ,&nbsp;Taisuke Jo ,&nbsp;Takehiro Izumo ,&nbsp;Hirokazu Urushiyama ,&nbsp;Hiroki Matsui ,&nbsp;Kiyohide Fushimi ,&nbsp;Hideaki Watanabe ,&nbsp;Hideo Yasunaga","doi":"10.1016/j.resinv.2024.07.010","DOIUrl":"10.1016/j.resinv.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><p>Transbronchial lung cryobiopsy (TBLC) is a new technique for obtaining high-quality and large-sized lung tissues, as compared to transbronchial forceps biopsy (TBFB), and is useful in the diagnosis of diffuse lung disease (DLD). We aimed to evaluate the safety of TBLC as compared to TBFB in DLD patients in Japan using a nationwide database.</p></div><div><h3>Methods</h3><p>Data were retrospectively collected from the Japanese Diagnosis Procedure Combination database from April 1, 2020 to March 31, 2022. Eligible patients (n = 9673) were divided into the following two groups: those who underwent TBFB (TBFB group, n = 8742) and TBLC (TBLC group, n = 931). To compare the outcomes between the two groups, a stabilized inverse probability of treatment weighting (IPTW) was applied using propensity scores. The primary outcome was in-hospital mortality, and the secondary outcomes were 28-day mortality, complications (mechanical ventilation, pneumothorax, and bleeding), and length of hospital stay after bronchoscopy.</p></div><div><h3>Results</h3><p>The crude in-hospital mortality rates were 3.2% and 0.9% in the TBFB and TBLC groups, respectively. The stabilized IPTW analysis showed no significant difference in the in-hospital mortality rates between the two groups; the odds ratio of the TBLC group as compared with the TBFB group was 0.73 (95% confidence interval: 0.34–1.60; <em>p</em> = 0.44). Moreover, the secondary outcomes did not significantly differ between the two groups.</p></div><div><h3>Conclusions</h3><p>TBLC for DLD patients had a similar mortality and complication rates as TBFB.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 844-849"},"PeriodicalIF":2.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760629","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":"Baseline lung allograft dysfunction after bilateral deceased-donor lung transplantation: A single-center experience in Japan","authors":"Miho Yamaguchi ,&nbsp;Mitsuaki Kawashima ,&nbsp;Tatsuya Muraoka ,&nbsp;Takafumi Yamaya ,&nbsp;Yue Cong ,&nbsp;Keita Nakao ,&nbsp;Masaaki Nagano ,&nbsp;Chihiro Konoeda ,&nbsp;Hidenori Kage ,&nbsp;Masaaki Sato","doi":"10.1016/j.resinv.2024.07.009","DOIUrl":"10.1016/j.resinv.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>Baseline lung allograft dysfunction (BLAD) refers to a condition in which a lung transplant recipient does not achieve normal pulmonary function (i.e., forced expiratory volume in 1 s or forced vital capacity of &lt;80% of predicted values). Although BLAD is reportedly associated with a poor prognosis, the condition has not been examined in Japanese patients.</p></div><div><h3>Methods</h3><p>In this study, we retrospectively examined 38 Japanese adults who underwent bilateral lung transplantation from 2015 to 2022 in a single center.</p></div><div><h3>Results</h3><p>Twenty-one (55%) patients met the criteria for BLAD. No significant differences were found in recipient or donor factors between the BLAD and non-BLAD groups, but the donor–recipient ratio of the predicted vital capacity was lower in the BLAD group (<em>p</em> = 0.009). The intensive care unit length of stay, ventilator duration, and blood loss during transplant surgery were significantly higher in the BLAD group (<em>p</em> &lt; 0.05). No significant difference was found in survival. The median observation period was significantly shorter in the BLAD than non-BLAD group (744 vs.1192 days, respectively; <em>p</em> = 0.031). The time to reach the normal threshold of pulmonary function after lung transplantation varied among the patients, ranging from 6 months to 4 years.</p></div><div><h3>Conclusions</h3><p>The characteristics of these Japanese patients with BLAD were similar to those of other patients in previous reports. The effects of the observation period and donor–recipient age discrepancy on BLAD require further exploration.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 838-843"},"PeriodicalIF":2.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212534524001102/pdfft?md5=fac5a56079a944fe09beb28ab2c249b5&pid=1-s2.0-S2212534524001102-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760628","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":"Nonfibrotic (cellular) hypersensitivity pneumonitis with and without slight lung distortion","authors":"Ryo Okuda ,&nbsp;Tamiko Takemura ,&nbsp;Toshihiro Misumi ,&nbsp;Akimasa Sekine ,&nbsp;Hideya Kitamura ,&nbsp;Tomohisa Baba ,&nbsp;Eri Hagiwara ,&nbsp;Takashi Ogura","doi":"10.1016/j.resinv.2024.07.008","DOIUrl":"10.1016/j.resinv.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><p>According to international diagnostic guidelines for hypersensitivity pneumonitis (HP), cases with both nonfibrotic and fibrotic lesions are classified by the predominant feature. Therefore, some cases with nonfibrotic HP, have inflammatory lesions alone, while others have a mixture of fibrosis and inflammation. We investigated the impact of slight fibrotic lesions in nonfibrotic HP.</p></div><div><h3>Methods</h3><p>This retrospective study included nonfibrotic HP cases with &lt;10% of lung distortion on high-resolution CT. We divided the cases into two groups: those with pure ground glass opacities (GGOs) without lung distortion and those with slight lung distortion of &lt;10%.</p></div><div><h3>Results</h3><p>In this study, 37 cases were included. The mean baseline forced vital capacity (FVC) was 109% in the pure GGO group and 96% in the slight lung distortion group (p = 0.038). After 1 year, the reticular shadows appeared or increased more in the slight lung distortion group than in the pure GGO group (16% vs. 8%, p = 0.030). The time to medication initiation was significantly shorter in the slight lung distortion group than in the pure GGO group (p = 0.044). %FVC decreased by ≥ 5% from diagnosis in no cases with the pure GGO and in two cases with the slight lung distortion (−11.0% for 9.5 years and −10.7% for 1.3 years, respectively).</p></div><div><h3>Conclusions</h3><p>The slight distortion group exhibited a higher rate of worsening and new appearance of reticular shadows after 1 year and a shorter time to first medication compared to the pure GGO group.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 832-837"},"PeriodicalIF":2.4,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727639","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":"What diagnostic tests are available for respiratory infections or pulmonary exacerbations in cystic fibrosis: A scoping literature review","authors":"Raasti Naseem,&nbsp;Nicola Howe,&nbsp;Cameron J. Williams,&nbsp;Sara Pretorius,&nbsp;Kile Green","doi":"10.1016/j.resinv.2024.07.005","DOIUrl":"10.1016/j.resinv.2024.07.005","url":null,"abstract":"<div><p>A scoping review methodological framework formed the basis of this review. A search of two electronic databases captured relevant literature published from 2013.</p><p>1184 articles were screened, 200 of which met inclusion criteria. Included studies were categorised as tests for either respiratory infections OR pulmonary exacerbations. Data were extracted to ascertain test type, sample type, and indication of use for each test type. For infection, culture is the most common testing method, particularly for bacterial infections, whereas PCR is utilised more for the diagnosis of viral infections. Spirometry tests, indicating lung function, facilitate respiratory infection diagnoses. There is no clear definition of what an exacerbation is in persons with CF. A clinical checklist with risk criteria can determine if a patient is experiencing an exacerbation event, however the diagnosis is clinician-led and will vary between individuals. Fuchs criteria are one of the most frequently used tests to assess signs and symptoms of exacerbation in persons with CF.</p><p>This scoping review highlights the development of home monitoring tests to facilitate earlier and easier diagnoses, and the identification of novel biomarkers for indication of infections/exacerbations as areas of current research and development. Research is particularly prevalent regarding exhaled breath condensate and volatile organic compounds as an alternative sampling/biomarker respectively for infection diagnosis. Whilst there are a wide range of tests available for diagnosing respiratory infections and/or exacerbations, these are typically used clinically in combination to ensure a rapid, accurate diagnosis which will ultimately benefit both the patient and clinician.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 817-831"},"PeriodicalIF":2.4,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212534524001060/pdfft?md5=aee1a8e0e76fe128b22bc50014df6c31&pid=1-s2.0-S2212534524001060-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141638241","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":"Prevalence and clinical relevance of comorbid pertussis infection in adult patients with asthma: A prospective, cross-sectional study","authors":"Hirono Nishiyama,&nbsp;Tomoko Tajiri,&nbsp;Ryota Kurokawa,&nbsp;Tatsuro Suzuki,&nbsp;Keima Ito,&nbsp;Yuta Mori,&nbsp;Kensuke Fukumitsu,&nbsp;Satoshi Fukuda,&nbsp;Yoshihiro Kanemitsu,&nbsp;Takehiro Uemura,&nbsp;Hirotsugu Ohkubo,&nbsp;Ken Maeno,&nbsp;Yutaka Ito,&nbsp;Tetsuya Oguri,&nbsp;Masaya Takemura,&nbsp;Akio Niimi","doi":"10.1016/j.resinv.2024.07.006","DOIUrl":"10.1016/j.resinv.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Viral or atypical bacterial respiratory infections are involved in the new development and the pathogenesis of asthma. Though an association between pertussis and asthma has been expected, few studies have reported it consistently. We assessed the prevalence and clinical relevance of pertussis infection in adult patients with asthma.</p></div><div><h3>Methods</h3><p>In this prospective, cross-sectional study, newly referred, adult patients with asthma (n = 107) and with non-asthmatic subacute/chronic cough (n = 31) were enrolled. The prevalence of pertussis in patients with asthma and in those with non-asthmatic subacute/chronic cough was assessed. Next, the prevalence of newly diagnosed asthma was compared between asthmatic patients with and without pertussis. Finally, demographic characteristics of patients, blood test results, pulmonary function test results, and questionnaire scores were compared between the two patient groups.</p></div><div><h3>Results</h3><p>The prevalence of pertussis infection was significantly higher in patients with asthma than in those with non-asthmatic subacute/chronic cough (36% vs 10%; <em>P</em> = 0.004). The prevalence of newly diagnosed asthma was significantly higher in asthmatic patients with pertussis than in those without (74.4% vs 50.0%; <em>P</em> = 0.014). The physical, psychological, and total scores of the Leicester Cough Questionnaire were significantly lower in asthmatic patients with pertussis than in those without (all <em>P</em> &lt; 0.05). The acid-reflux, dyspeptic, and total scores of the Frequency Scale for Symptoms of Gastroesophageal Reflux Disease (GERD) (FSSG) were significantly higher in asthmatic patients with pertussis than in those without (all <em>P</em> ≤ 0.05). The FSSG acid-reflux score was negatively correlated with the cough-specific quality of life (QOL) score only in asthmatic patients with pertussis (rho = −0.68, <em>P</em> = 0.01).</p></div><div><h3>Conclusions</h3><p>The prevalence of pertussis infection was significantly higher in adult patients with asthma than in those with non-asthmatic subacute/chronic cough. In patients with asthma, comorbid pertussis infection may play a role in newly diagnosed asthma and may contribute to impaired cough-specific QOL partly due to worsening acid-reflux symptoms of GERD.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 811-816"},"PeriodicalIF":2.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141630643","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":"Augmented humoral response to third and fourth dose of SARS-CoV-2 mRNA vaccines in lung transplant recipients","authors":"Shinichi Kawana ,&nbsp;Seiichiro Sugimoto ,&nbsp;Kei Matsubara ,&nbsp;Haruki Choshi ,&nbsp;Shin Tanaka ,&nbsp;Megumi Ishihara ,&nbsp;Tomohiro Habu ,&nbsp;Kohei Hashimoto ,&nbsp;Ken Suzawa ,&nbsp;Kazuhiko Shien ,&nbsp;Kentaroh Miyoshi ,&nbsp;Mikio Okazaki ,&nbsp;Masanori Nakayama ,&nbsp;Shinichi Toyooka","doi":"10.1016/j.resinv.2024.07.004","DOIUrl":"10.1016/j.resinv.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><p>Since lung transplant recipients (LTRs) exhibit low immunogenicity after two doses of SARS-CoV-2 mRNA vaccines, optimal vaccine strategies for SARS-CoV-2 are required in LTRs. This study aimed to investigate the efficacy and safety of the third and fourth doses of the SARS-CoV-2 mRNA vaccines in LTRs.</p></div><div><h3>Methods</h3><p>We conducted a single-center study of 73 LTRs and 23 healthy controls (HCs). Participants received two-to-four doses of SARS-CoV-2 mRNA vaccines. The LTRs were divided into three groups based on the number of vaccine dose. IgG titers against SARS-CoV-2 spike protein were measured, and adverse events were assessed. Factors associated with humoral response were analyzed using univariate and multivariate analyses.</p></div><div><h3>Results</h3><p>The Dose 4 group (n = 27) had a higher humoral response rate (<em>P</em> = 0.018) and higher levels of anti-SARS-CoV-2 IgG antibody (<em>P</em> = 0.04) than the Dose 2 group (n = 14). The Dose 3 group (n = 32) had lower humoral response rates (<em>P</em> = 0.005) and levels of anti-SARS-CoV-2 IgG antibody (<em>P</em> = 0.0005) than the HCs (n = 23) even after the same dose. Systemic adverse events were milder in the LTRs than in the HCs (<em>P</em> &lt; 0.05). Increased number of vaccine dose was identified as a predictor of positive humoral response (<em>P</em> = 0.021).</p></div><div><h3>Conclusion</h3><p>Booster doses of SARS-CoV-2 mRNA vaccines may enhance humoral response with mild adverse events in LTRs. Repeated vaccination might be warranted for LTRs to prevent SARS-CoV-2 infection.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 804-810"},"PeriodicalIF":2.4,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604040","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":"Allelic frequency of pathogenic α1-antitrypsin variants in the Japanese population: Results from a survey of open Japanese genetic variation databases","authors":"Kuniaki Seyama ,&nbsp;Tadashi Sato ,&nbsp;Susumu Sato ,&nbsp;Toyohiro Hirai ,&nbsp;The Intractable Respiratory Diseases and Pulmonary Hypertension Research Group, Ministry of Health, Labour and Welfare of Japan","doi":"10.1016/j.resinv.2024.07.001","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.07.001","url":null,"abstract":"<div><p>α₁-antitrypsin deficiency (AATD) is a hereditary disorder with a global prevalence that differs across regions. AATD is highly prevalent in Europe and North America but rarely found in Asian countries, including Japan, possibly because of the founder effect of the pathogenic <em>SERPINA1</em> variants PI*Z and PI*S. However, AATD remains underdiagnosed even in high-prevalence and low-prevalence regions, possibly because of lack of awareness. In this study, we surveyed open Japanese genetic variation databases to estimate AATD prevalence in Japan. We identified allelic frequencies (AFs) of 5 among the 14 major pathogenic <em>SERPINA1</em> variants from three datasets, collectively derived from 63,119 Japanese participants. The mean AF was determined to be 8.56 × 10⁻⁴ (95% confidence interval [CI]: 6.43 × 10⁻⁴ to 1.12 × 10⁻³). Given that this represents the entire Japanese population, one AATD patient was speculated to be born per 1.37 × 10⁶ births (95% CI: 7.97 × 10⁵ to 2.42 × 10⁶) in Japan. Our results support the prevailing notion that AATD is extremely rare in Japan.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 794-797"},"PeriodicalIF":2.4,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592878","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":"Validation of a computed tomography diagnostic model for differentiating fibrotic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis","authors":"Hiromitsu Sumikawa ,&nbsp;Kosaku Komiya ,&nbsp;Ryoko Egashira ,&nbsp;Junya Tominaga ,&nbsp;Midori Ueno ,&nbsp;Taiki Fukuda ,&nbsp;Daisuke Yamada ,&nbsp;Reoto Takei ,&nbsp;Kensuke Kataoka ,&nbsp;Tomoki Kimura ,&nbsp;Yasuhiro Kondoh ,&nbsp;Masaru Ejima ,&nbsp;Takashi Shimamura ,&nbsp;Tomoya Tateishi ,&nbsp;Hiromi Tomioka ,&nbsp;Yasunari Miyazaki ,&nbsp;Takafumi Suda ,&nbsp;Takeshi Johkoh","doi":"10.1016/j.resinv.2024.07.002","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><p>The diagnosis of fibrotic hypersensitivity pneumonitis (fHP) from other interstitial lung diseases, particularly idiopathic pulmonary fibrosis (IPF), is often difficult. This study aimed to examine computed tomography (CT) findings that were useful for differentiating between fHP and IPF and to develop and validate a radiological diagnostic model.</p></div><div><h3>Methods</h3><p>In this study, 246 patients (fHP, n = 104; IPF, n = 142) from two institutions were included and randomly divided into the test (n = 164) and validation (n = 82) groups (at a 2:1 ratio). Three radiologists evaluated CT findings, such as pulmonary fibrosis, small airway disease, and predominant distribution, and compared them between fHP and IPF using binomial logistic regression and multivariate analysis. A prognostic model was developed from the test group and validated with the validation group.</p></div><div><h3>Results</h3><p>Ground-glass opacity (GGO) with traction bronchiectasis (TB), honeycombing, hypoattenuation area, three-density pattern, diffuse craniocaudal distribution, peribronchovascular opacities in the upper lung, and random distribution were more common in fHP than in IPF. In multivariate analysis, GGO with TB, peribronchovascular opacities in the upper lung, and random distribution were significant features. The area under the curve of the fHP diagnostic model with the three aforementioned CT features was 0.733 (95% confidence interval [CI], 0.655–0.811, <em>p</em> &lt; 0.001) in the test group and 0.630 (95% CI, 0.504–0.755, <em>p</em> &lt; 0.047) in the validation group.</p></div><div><h3>Conclusion</h3><p>GGO with TB, peribronchovascular opacities in the upper lung, and random distribution were important CT features for differentiating fHP from IPF.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 798-803"},"PeriodicalIF":2.4,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594747","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":"Current challenges in the diagnosis and management of idiopathic pulmonary fibrosis in Japan","authors":"Masashi Bando ,&nbsp;Hirofumi Chiba ,&nbsp;Yasunari Miyazaki ,&nbsp;Takafumi Suda","doi":"10.1016/j.resinv.2024.06.006","DOIUrl":"https://doi.org/10.1016/j.resinv.2024.06.006","url":null,"abstract":"<div><p>Idiopathic pulmonary fibrosis (IPF) is the archetypal interstitial lung disease. It is a chronic progressive condition that is challenging to manage as the clinical course of the disease is often difficult to predict. The prevalence of IPF is rising globally and in Japan, where it is estimated to affect 27 individuals per 100,000 of the population. Greater patient numbers and the poor prognosis associated with IPF diagnosis mean that there is a growing need for disease management approaches that can slow or even reverse disease progression and improve survival. Considerable progress has been made in recent years, with the approval of two antifibrotic therapies for IPF (pirfenidone and nintedanib), the availability of Japanese treatment guidelines, and the creation of global and Japanese disease registries. Despite this, significant unmet needs remain with respect to the diagnosis, treatment, and management of this complex disease. Each of these challenges will be discussed in this review, including making a timely and differential diagnosis of IPF, uptake and adherence to antifibrotic therapy, patient access to pulmonary rehabilitation, lung transplantation and palliative care, and optimal strategies for monitoring and staging disease progression, with a particular focus on the status in Japan. In addition, the review will reflect upon how ongoing research, clinical trials of novel therapies, and technologic advancements (including artificial intelligence, biomarkers, and genomic classification) may help address these challenges in the future.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 785-793"},"PeriodicalIF":2.4,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594923","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":"Changing clinical practice and prognosis for severe respiratory failure over time: A nationwide inpatient database study","authors":"Takuo Yoshida ,&nbsp;Sayuri Shimizu ,&nbsp;Kiyohide Fushimi ,&nbsp;Takahiro Mihara","doi":"10.1016/j.resinv.2024.07.003","DOIUrl":"10.1016/j.resinv.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Severe respiratory failure requires numerous interventions and its clinical implementation changes over time. We aimed to clarify the clinical practice and prognosis of severe respiratory failure and its changes over time.</p></div><div><h3>Methods</h3><p>In a nationwide Japanese administrative database from 2016 to 2019, we identified nonoperative patients with severe respiratory failure without congestive heart failure as the main diagnosis who received mechanical ventilation (MV) for more than four days. We examined trends in patient characteristics, adjunctive interventions, and prognosis.</p></div><div><h3>Results</h3><p>Among 66,905 patients included in this study, patients received antibiotics (90%), high-dose corticosteroids (14%), low-dose corticosteroids (18%), and 51% were admitted to the critical care unit. Hospital mortality was 35%. Median mechanical ventilation lasted 10 days. Tracheostomy occurred in 23% of cases. Median critical care and hospital stays were 10 and 25 days, respectively. Among survivors, 23% had mechanical ventilation dependency at hospital discharge. Large relative changes in adjunctive therapies included fentanyl (30%–38%), rocuronium (4.4%–6.7%), vasopressin (3.8%–6.0%), early rehabilitation (27%–38%), extracorporeal membrane oxygenation (0.7%–1.2%), dopamine (15%–10%), and sivelestat (8.6%–3.5%). No notable changes were seen in mechanical ventilation duration, tracheostomy, critical care unit stay, hospital stay, or ventilator dependency at discharge, except for a slight reduction in hospital mortality (36%–34%).</p></div><div><h3>Conclusions</h3><p>Several adjunctive therapies for severe respiratory failure changed from 2016 to 2019, with an increase in evidence-based practices and a slight decrease in hospital mortality.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 5","pages":"Pages 778-784"},"PeriodicalIF":2.4,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580723","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}