Respiratory investigation最新文献

{"title":"BAL cells analysis and lung function parameters in fibrotic hypersensitivity pneumonitis at baseline and in relation to survival","authors":"Punchalee Kaenmuang ,&nbsp;Fiammetta Danzo ,&nbsp;Simon Bax ,&nbsp;Richard J. Hewitt ,&nbsp;Maria Kokosi ,&nbsp;Vasileios Kouranos ,&nbsp;Felix Chua ,&nbsp;Peter M. George ,&nbsp;Gisli Jenkins ,&nbsp;Athol U. Wells ,&nbsp;Carmel JW. Stock ,&nbsp;Piersante Sestini ,&nbsp;Elisabetta A. Renzoni","doi":"10.1016/j.resinv.2025.101359","DOIUrl":"10.1016/j.resinv.2025.101359","url":null,"abstract":"<div><div>In fibrotic hypersensitivity pneumonitis, the relevance of bronchoalveolar lavage (BAL) lymphocytosis remains unclear. We investigated the relationship between BAL %lymphocytes, baseline pulmonary function tests (PFTs) and transplant-free survival. We retrospectively analysed 162 treatment-naïve patients (median age 64 years; 43 % male; 39 % ever-smokers) undergoing BAL within three months of PFTs. Mean FVC 79 %, DLCO 43 %, composite physiologic index (CPI) 48. Median BAL lymphocytes were 24 %(IQR 21–28). BAL %lymphocytes were associated with less severe disease, FVC [coefficient 0.28 (95 %C.I. 0.06–0.48), p = 0.01], FEV₁ [0.20(0.0002–0.41), p = 0.05], and CPI [-0.11(-0.21 to −0.01, p = 0.04]. Although BAL% lymphocytes were not correlated with DLCO, significant opposite correlations were observed for its two components: positive with VA% [0.32 (0.18–0.45), p &lt; 0.0005]; negative with KCO% [-0.37(-0.51 to −0.23), p &lt; 0.0005<strong>].</strong> In adjusted Cox regression models, BAL %lymphocytes, lower CPI, higher %FVC, %FEV₁ and %DLCO were significantly associated with increased survival. These findings suggest BAL lymphocytosis reflects a pathophysiological pattern linked to better outcomes.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101359"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883568","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":"How to choose a biologic agent considering comorbidities of bronchial asthma","authors":"Masamichi Itoga,&nbsp;Sadatomo Tasaka","doi":"10.1016/j.resinv.2025.101337","DOIUrl":"10.1016/j.resinv.2025.101337","url":null,"abstract":"<div><div>Biologic therapies have revolutionized the treatment of severe asthma. However, the selection of the optimal biologic agent remains challenging because of the heterogeneity of disease phenotypes and frequent comorbidities. This mini-review explored the clinical relevance of comorbidities in the selection of biologics for patients with asthma.</div><div>Herein, we summarize recent evidence on the prevalence of comorbidities associated with type 2 inflammation, including chronic spontaneous urticaria, atopic dermatitis, prurigo nodularis, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis, eosinophilic otitis media, aspirin-exacerbated respiratory disease, allergic rhinitis, allergic bronchopulmonary mycosis, obesity, and chronic obstructive pulmonary disease, and review the efficacy of five major biologics (omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab) in these settings. Each biologic targets distinct immunologic pathways in type 2 inflammation, including IgE, IL-5, IL-5Rα, IL-4Rα, and thymic stromal lymphopoietin, respectively.</div><div>In conclusion, the assessment of comorbidities in addition to biomarkers is essential for tailoring biologic therapies for severe asthma. Integrating comorbidity profiles into treatment strategies allows for a more precise and effective use of biologics, ultimately improving outcomes in complicated asthma cases.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101337"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616019","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":"Oscillometrically assessed higher respiratory reactance is associated with impaired lung function and poorer prognosis in patients with fibrotic idiopathic interstitial pneumonias","authors":"Yuya Yamamoto ,&nbsp;Taisuke Akamatsu ,&nbsp;Keita Hirai ,&nbsp;Toshihiro Shirai","doi":"10.1016/j.resinv.2025.101352","DOIUrl":"10.1016/j.resinv.2025.101352","url":null,"abstract":"<div><h3>Background</h3><div>Fibrotic idiopathic interstitial pneumonias (IIPs) are progressive lung diseases with variable prognoses. Oscillometry, a non-invasive method for assessing respiratory impedance, has emerged as a potential tool for disease stratification. However, the association between standardized respiratory reactance (Xrs) measured by oscillometry and clinical outcomes in IIPs, including those other than idiopathic pulmonary fibrosis, remains unclear. Therefore, we investigated this association.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 101 patients with fibrotic IIPs treated at Shizuoka General Hospital from 2017 to 2022. Fibrosis was defined by high-resolution computed tomography findings of honeycombing, traction bronchiectasis, or subpleural reticulation. Patients were categorized into high-Xrs or low-Xrs groups based on whether Xrs parameters (X5, Fres, or AX) exceeded 1.64 standard deviations above Japanese standard values. The primary outcome was mortality. Cox proportional hazards analysis identified prognostic factors.</div></div><div><h3>Results</h3><div>Among 101 patients, 25 (24.8 %) were classified as high-Xrs. Median overall survival was significantly shorter in the high-Xrs group (21.1 months; 95 % CI, 13.2–43.3) compared to the low-Xrs group (78.7 months; 95 % CI, 56.8–not reached). A subgroup analysis of IPF and non-IPF patients showed significant survival differences between the high-Xrs and low-Xrs groups. Multivariate analysis identified low %FVC and high-Xrs classification as independent predictors of mortality.</div></div><div><h3>Conclusions</h3><div>High respiratory reactance measured by oscillometry was independently associated with impaired lung function and poor prognosis in patients with fibrotic IIPs. Oscillometry may be a valuable tool for risk stratification and prognostic assessment in this patient population.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101352"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736941","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 atropine and hydroxyzine pretreatment in contemporary bronchoscopy","authors":"Kazuo Tsuchiya,&nbsp;Ryota Miyamoto,&nbsp;Tomo Tsunoda,&nbsp;Taisuke Ito,&nbsp;Takuro Akashi,&nbsp;Yoshiyuki Oyama,&nbsp;Masaki Ikeda","doi":"10.1016/j.resinv.2025.11.012","DOIUrl":"10.1016/j.resinv.2025.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Bronchoscopy is essential for diagnosing and managing respiratory diseases. However, secretions and airway reflexes can impair procedural quality and patient comfort. While anticholinergic pretreatment using agents such as atropine and hydroxyzine has historically mitigated these physiological responses, recent guidelines discourage their routine use because of concerns regarding hemodynamic changes and uncertain benefits. This study aimed to assess the efficacy of anticholinergic pretreatment during contemporary bronchoscopy.</div></div><div><h3>Methods</h3><div>We conducted a single-center, cross-sectional study comparing two cohorts of patients who underwent bronchoscopy with transbronchial and ultrasound-guided needle biopsies. Group A (n = 35) received pretreatment with intramuscular atropine (0.5 mg) and hydroxyzine (25 mg) between July 2022 and September 2023, while Group B (n = 35) underwent procedures without pretreatment between December 2024 and March 2025. Patient discomfort was evaluated using a visual analog scale. Propensity score adjustment with inverse probability of treatment weighting (IPTW) accounted for differences in baseline factors.</div></div><div><h3>Results</h3><div>Seventy patients were included (n = 35 per group). After IPTW adjustment, Group B reported greater distress from salivation and cough and lower willingness for repeat bronchoscopy (p = 0.03, p = 0.02, p = 0.001, respectively). Group B also showed higher use of lidocaine (<em>p</em> &lt; 0.001). No significant differences in midazolam dosage or vital signs were observed among either group.</div></div><div><h3>Conclusion</h3><div>Anticholinergic pretreatment may reduce procedural discomfort, particularly that associated with secretions and airway reflexes, without evident adverse effects. Further randomized controlled trials are required to validate the role of pretreatment in contemporary bronchoscopy.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101333"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571140","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":"Non-vascular interventional radiology techniques versus video-assisted thoracoscopic surgery in stage II–III empyema: a retrospective cohort study","authors":"Yoshio Nakano ,&nbsp;Masahisa Nakamura ,&nbsp;Iwao Gohma","doi":"10.1016/j.resinv.2025.101356","DOIUrl":"10.1016/j.resinv.2025.101356","url":null,"abstract":"<div><h3>Background</h3><div>Empyema often requires surgery such as video-assisted thoracoscopic surgery (VATS). Minimally invasive nonvascular interventional radiology (IR) techniques, including hydrodissection and guidewire dissection, may be alternatives. We compared outcomes of IR and VATS for stage II–III empyema.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 45 patients with stage II–III empyema treated at a single center between April 2021 and October 2024 (IR, n = 23; VATS, n = 22). Primary treatment success was resolution without conversion to surgical management; repeat IR procedures were considered part of the IR strategy. Groups were compared using appropriate statistical tests (p &lt; 0.05).</div></div><div><h3>Results</h3><div>The Primary treatment success was 87.0 % (20/23) in the IR group and 100 % (22/22) in the VATS group (p = 0.233). The overall clinical outcome, including cases that required subsequent surgery, was 95.6 % in the IR group and 100 % in the VATS group (p = 1). One patient in the IR group required three IR sessions, all performed through the same access site. While IR recipients were significantly older (median 78.0 versus [vs.] 71.5 years; p = 0.046) and had worse performance status (p = 0.015), there was no significant difference in hospital stay, drainage duration, or antibiotic therapy. Ninety-day mortality was 8.7 % (2/23) for IR and 0 % (0/22) for VATS (p = 0.49), with no procedure-related deaths.</div></div><div><h3>Conclusion</h3><div>In this cohort, no statistically significant difference in overall outcomes was observed between IR-based management and VATS for stage II–III empyema.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101356"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865196","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 risk of recurrence in pathological stage II-IIIA non-small cell lung cancer without lymph node metastasis","authors":"Ryusuke Sumiya ,&nbsp;Takeshi Matsunaga ,&nbsp;Yukio Watanabe ,&nbsp;Hisashi Tomita ,&nbsp;Takuo Hayashi ,&nbsp;Mariko Fukui ,&nbsp;Aritoshi Hattori ,&nbsp;Kazuya Takamochi ,&nbsp;Kenji Suzuki","doi":"10.1016/j.resinv.2025.101349","DOIUrl":"10.1016/j.resinv.2025.101349","url":null,"abstract":"<div><h3>Background</h3><div>According to LACE analysis, patients diagnosed with p-Stage II-III non-small cell lung cancer (NSCLC) are usually indicated for adjuvant chemotherapy, including platinum doublets. We aimed to identify the risk of recurrence in NSCLC patients without lymph node metastasis.</div></div><div><h3>Methods</h3><div>Between 2009 and 2018, 187 patients underwent lung resection of one or more lobes and mediastinal lymph node dissection for p-Stage II-IIIA NSCLC. Among them, 112 were included after excluding those with a history of lung cancer, perioperative chemotherapy. Staging was based on 8th Edition of IASLC staging system. Multivariate analysis was performed to identify important prognostic factors for oncologic outcomes.</div></div><div><h3>Results</h3><div>Among the evaluated patients, 84 were male, and with a median age of 67 years. Seventy-one (51.4 %) patients were diagnosed with adenocarcinoma. The cancer stages were stage IIA in 34 patients, stage IIB in 57 patients, and stage IIIA in 21 patients. Multivariate analysis of disease-free survival revealed that vascular invasion (HR, 2.481; 95 %CI, 1.411–4.362, P &lt; 0.01) and pathological T factor (HR, 1.819; 95 %CI, 1.226–2.699, P &lt; 0.01) were the independent risk factors. Gray's test for equality of cumulative incidence functions revealed that the five-year cumulative incidence of recurrence was particularly high in patients with vascular invasion compared to that in patients without vascular invasion (21.5 % vs. 37.5 %, P = 0.03).</div></div><div><h3>Conclusions</h3><div>Vascular invasion is a significant predictor of lung cancer recurrence in patients with p-Stage II-IIIA NSCLC without lymph node metastasis. The patients without vascular invasion in this cohort had a favorable prognosis, with a 5-year recurrence rate of 21.5 %.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101349"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786956","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":"Ultrasound-guided percutaneous core biopsy of thoracic lesions: Diagnostic yield and site-specific safety","authors":"Yosuke Murakami,&nbsp;Shota Sogabe,&nbsp;Kazuki Uchida,&nbsp;Takafumi Kawabata,&nbsp;Hiroaki Ota,&nbsp;Yuri Hiramatsu,&nbsp;Mitsukuni Sakabe,&nbsp;Ryuta Yamamoto,&nbsp;Ryunosuke Oi,&nbsp;Akiko Maeda,&nbsp;Kohei Yoshimine,&nbsp;Saori Nishizawa,&nbsp;Hiromi Ide,&nbsp;Minako Hanaka,&nbsp;Kazunori Tobino","doi":"10.1016/j.resinv.2025.101347","DOIUrl":"10.1016/j.resinv.2025.101347","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound (US)-guided percutaneous biopsy is increasingly being used for thoracic lesions abutting the chest wall; however, its comparative safety according to puncture site remains unclear. We assessed the diagnostic yield and complications of bedside US-guided core needle biopsy.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the medical records of 168 consecutive patients who underwent pulmonologist-performed bedside core biopsy using an 18-gauge needle under real-time US guidance without a coaxial system between April 2011 and July 2022 at a single center. Typically, two to three passes were performed. Lesions were prospectively classified ultrasonographically as solid or heterogeneous. Diagnostic yield and complications were graded using the Clavien–Dindo system and compared according to puncture site and lesion morphology.</div></div><div><h3>Results</h3><div>Adequate tissue was obtained in 159 (94.6 %) patients. The final diagnosis was malignancy, infection, and other benign conditions in 81.8 %, 13.8 %, and 4.4 % patients, respectively. Complications occurred in 7.1 % of patients, and pneumothorax was the most frequent complication (4.7 %). All complications were managed conservatively. Grade IV–V adverse events occurred in three (1.5 %) patients undergoing lung parenchymal biopsies. Of these, one patient died during follow-up due to pleural dissemination along the biopsy tract. No adverse events ≥ Grade III occurred after chest-wall, pleural, or mediastinal biopsies. No adverse events occurred in 156 patients.</div></div><div><h3>Conclusions</h3><div>US-guided percutaneous core biopsy has a high diagnostic accuracy and low complication rate. However, safety varies according to site, with serious adverse events limited to patients with lung parenchymal targets. US-guided core biopsy is a feasible first-line approach for accessible extrapulmonary thoracic lesions; however, careful consideration is required for intrapulmonary targets.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101347"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681715","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":"Age-related factors associated with preserved ratio impaired spirometry: The Tohoku medical Megabank project community-based cohort study","authors":"Chikashi Iwasaki ,&nbsp;Kumi Nakaya ,&nbsp;Mitsuhiro Yamada ,&nbsp;Naoki Nakaya ,&nbsp;Mana Kogure ,&nbsp;Rieko Hatanaka ,&nbsp;Ippei Chiba ,&nbsp;Masato Takase ,&nbsp;Sayuri Tokioka ,&nbsp;Taku Obara ,&nbsp;Masatsugu Orui ,&nbsp;Naoya Fujino ,&nbsp;Akira Koarai ,&nbsp;Tomoko Kobayashi ,&nbsp;Yohei Hamanaka ,&nbsp;Eiichi N Kodama ,&nbsp;Satoshi Nagaie ,&nbsp;Soichi Ogishima ,&nbsp;Nobuo Fuse ,&nbsp;Shinichi Kuriyama ,&nbsp;Atsushi Hozawa","doi":"10.1016/j.resinv.2025.101343","DOIUrl":"10.1016/j.resinv.2025.101343","url":null,"abstract":"<div><h3>Background</h3><div>Preserved ratio impaired spirometry (PRISm), defined as a forced expiratory volume in 1 s (FEV₁) to forced vital capacity (FVC) ratio ≥0.70 and a predicted FEV₁ &lt;80 %, is associated with increased morbidity and mortality. However, determinants of PRISm, particularly in younger populations, remain poorly characterised. We aimed to address this knowledge gap.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of 12,350 participants from a Japanese community-based cohort using data from the Tohoku Medical Megabank Project. Participants underwent spirometry, blood pressure measurement, laboratory testing, and completed standardised questionnaires. Multivariate logistic regression was used to identify factors associated with PRISm across three age groups: 20–39, 40–59, and ≥60 years. Interactions between age groups and other explanatory variables were assessed.</div></div><div><h3>Results</h3><div>In the 20–39-year group, PRISm was independently associated with being men, diabetes mellitus, hypothyroidism, and low body mass index (BMI &lt;18.5 kg/m²), and inversely associated with age. Among participants aged ≥60 years, PRISm was significantly associated with increasing age, overweight status (BMI ≥25.0–&lt;30.0 kg/m²), being men, current smoking, hypertension, diabetes mellitus, bronchial asthma, elevated eosinophil counts (≥300 cells/μL), and birth weight ≥2000–&lt;2500 g. Significant interactions were observed between age and BMI, bronchial asthma, and thyroid dysfunction.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that PRISm in younger adults is associated with hypothyroidism and underweight status, whereas in older adults, it is more closely related to constitutional and lifestyle-related factors. These results highlight the heterogeneity of PRISm and indicate that its pathophysiology and optimal management may vary by age group.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101343"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681716","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 tracheostomy tube removal following airway clearance using intrapulmonary percussive ventilation treatment after bilateral lung transplantation in a patient with idiopathic pleuroparenchymal fibroelastosis","authors":"Satoshi Hamada ,&nbsp;Tomohiko Yamaguchi ,&nbsp;Yohei Oshima ,&nbsp;Yoshihiro Nishino ,&nbsp;Satona Tanaka ,&nbsp;Daisuke Nakajima ,&nbsp;Toyohiro Hirai","doi":"10.1016/j.resinv.2025.101336","DOIUrl":"10.1016/j.resinv.2025.101336","url":null,"abstract":"<div><div>Sputum management is a critical and potentially lethal issue in patients following lung transplantation. Here, we describe a patient with idiopathic pleuroparenchymal fibroelastosis who underwent tracheotomy after deceased donor bilateral lung transplantation, in whom we were unable to remove the tracheostomy tube due to difficulty in sputum evacuation. The tube was successfully removed following the subsequent initiation of intrapulmonary percussive ventilation (IPV) treatment combined with pulmonary rehabilitation. IPV has been widely used for several decades for treating pulmonary conditions, including chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis. However, it should also be considered for airway clearance after lung transplantation.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101336"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616021","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 pneumothorax on clinical course of patients with amyotrophic lateral sclerosis on long-term ventilation","authors":"Nobuhiro Okagaki ,&nbsp;Tomomasa Tsuboi ,&nbsp;Yuichi Chihara ,&nbsp;Kensuke Sumi ,&nbsp;Hiroki Takeuchi ,&nbsp;Kenji Yamamoto ,&nbsp;Takashi Hajiro ,&nbsp;Atsuo Sato","doi":"10.1016/j.resinv.2025.11.008","DOIUrl":"10.1016/j.resinv.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Numerous clinical studies have shown that long-term positive pressure ventilation (PPV) improves quality of life and prognosis in patients with amyotrophic lateral sclerosis (ALS). Pneumothorax is an important complication of PPV; however, few studies investigated pneumothorax in patients with ALS on long-term PPV.</div></div><div><h3>Methods</h3><div>This retrospective longitudinal cohort study included 85 patients with ALS treated from 2013 to 2024. We collected information from medical records on ALS and pneumothorax treatment, blood laboratory data, radiology data, equipment data, and mortality. Subsequently, we compared clinical parameters and prognosis between the pneumothorax and non-pneumothorax groups.</div></div><div><h3>Results</h3><div>Of the 85 patients, 61 underwent long-term PPV. Nine patients developed pneumothorax following the initiation of long-term PPV. In contrast, 24 patients without long-term PPV did not experience pneumothorax. Among patients who received tracheostomy PPV as a maximum respiratory management, the pneumothorax group tended to have a poorer prognosis from ALS onset than the non-pneumothorax group. Moreover, the pneumothorax group had higher inspiratory positive airway pressure and support pressure of ventilator settings than the non-pneumothorax group. Among the nine pneumothorax cases, there were no deaths directly related to the complication, two patients who developed pneumothorax during non-invasive PPV transitioned to tracheostomy PPV as a result of the complication.</div></div><div><h3>Conclusions</h3><div>Pneumothorax should be recognized as a serious complication that can occur in patients with ALS on PPV. Higher inspiratory positive airway pressure and support pressure settings on long-term PPV may be significant risk factors for pneumothorax.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101329"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532473","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}