Respiration最新文献

{"title":"Beyond Hypersecretion: Mucus Plugs as structural and biological determinants of Airway Obstruction.","authors":"Jennifer Patricia Vargas Gómez, Juan Camilo Tafur Vidal, Vanessa Rocio Villanueva Guerrero, Jorge Mario Ahumada Ramírez, Eidelman Antonio González Mejia, Isaias Alberto Siado Palencia, Joseph David León Insignares, Evelyn Mendoza Torres","doi":"10.1159/res/aepag012","DOIUrl":"https://doi.org/10.1159/res/aepag012","url":null,"abstract":"<p><p>Mucus plugs represent a muco-obstructive endophenotype across the spectrum of chronic obstructive airway diseases. Beyond reflecting mucus hypersecretion alone, they constitute a structural and biological manifestation of altered mucus biophysics, impaired mucociliary clearance, epithelial dysfunction, and inflammatory signaling. Their presence contributes to regional airflow limitation, ventilation heterogeneity, hypoxemia, and adverse clinical outcomes, even when conventional pulmonary function tests underestimate their impact. Advances in imaging have enabled the transition of mucus plugs from a descriptive radiologic finding to a potentially actionable biomarker for risk stratification and therapeutic response assessment, particularly in severe asthma and chronic obstructive pulmonary disease, where muco-obstruction has been associated with increased exacerbation risk and mortality. This narrative review integrates current evidence on the mechanisms underlying plug formation and persistence, their clinical expression, imaging strategies, and therapeutic implications across asthma and chronic obstructive pulmonary disease.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonsmoking Lung Adenocarcinoma: Uncovering Divergent Tumor Architectures and Female Predominance in Never-Smokers.","authors":"Erik Rolf, Benedikt Niedermaier, Michael Allgäuer, Laura V Klotz, Marc A Schneider, Martin E Eichhorn, Hauke Winter","doi":"10.1159/res/aepag013","DOIUrl":"10.1159/res/aepag013","url":null,"abstract":"<p><strong>Introduction: </strong>Smoking is the main risk factor for the development of lung adenocarcinoma (LUAD), but a significant and growing proportion of patients develop LUAD without prior tobacco use. It remains unclear how smoking-associated and nonsmoking LUAD differ in terms of different growth patterns and tumor grading.</p><p><strong>Methods: </strong>This retrospective cohort study included all consecutive patients with pathologic stage I non-mucinous LUAD who underwent curative surgery with complete resection (R0) between 2010 and 2020. Patients were stratified by history of smoking. Differences in demographic, pathologic and survival data were analyzed.</p><p><strong>Results: </strong>507 patients were included in this study. In total, 409 (80.6%) patients were active or former smokers, and 98 (19.3%) were nonsmokers. In the nonsmoker group, there was a significantly higher proportion of females (75.5% vs. 45.7% in the smoker group, p < 0.001). Based on the current IASLC grading system, nonsmokers had a higher proportion of tumors with favorable tumor grading (grade 1: 19.4% vs. 10.0%, p = 0.010; grade 3: 26.5% vs. 42.1%; p = 0.005). Lepidic-predominant tumors occurred almost twice as frequently in nonsmokers as in smokers (19.4% vs. 10.5%, p = 0.016). The opposite was true for solid-predominant tumors (6.1% vs. 14.4%, p = 0.027). It is noteworthy that this trend was observed independently in both females and males. With a median follow-up time of 69 months, multivariable Cox regression analysis showed a significant influence of smoking on recurrence-free survival (HR 1.84 [1.14-2.96], p = 0.012).</p><p><strong>Conclusion: </strong>Our results highlight that while nonsmoking LUAD mostly affects women, the association of favorable histologic subtypes and never-smokers is independent of patient sex. Further research is warranted to clarify the molecular mechanisms associated with this observation.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation and cross-cultural adaptation into Italian, French, and German of the Undiagnosed COPD and Asthma Population Questionnaire (UCAP-Q): the Swiss UCAP-Q.","authors":"Dan Adler, Anthony Pernoud, Matteo Arrigotti, Anastasia Cortese, Christian F Clarenbach, Shawn D Aaron, Vittoria Viganò, Pietro Gianella","doi":"10.1159/res/aepag010","DOIUrl":"https://doi.org/10.1159/res/aepag010","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection of asthma and chronic obstructive pulmonary disease improves outcomes, yet population screening is not recommended. The Undiagnosed COPD and Asthma Population Questionnaire (UCAP-Q) is a recently validated self-administered questionnaire designed to detect individuals at risk of asthma and COPD. The purpose was to translate and cross-culturally adapt the UCAP-Q into Italian (UCAP-Q-It), French (UCAP-Q-Fr), and German (UCAP-Q-De).</p><p><strong>Methods: </strong>Translations and cross-cultural adaptations followed a standardized 10-step process, including forward and backward translation, expert review, harmonization, and cognitive debriefing. Thirty native-speaking adults with respiratory symptoms (10 per language) assessed item comprehensibility using a 10-point scale. Feedback was used to refine wording and ensure conceptual and cultural equivalence.</p><p><strong>Results: </strong>Minor linguistic adjustments were required, particularly for smoking exposure and bronchodilator use. Back translations closely matched the original questionnaire, with only one minor discrepancy identified and corrected. Comprehensibility was high across all versions, with mean scores of 9.9±0.8 (Italian), 9.7±0.8 (French), and 9.3±1.5 (German). A small number of items were revised for clarity, including the addition of explicit response anchors.</p><p><strong>Conclusion: </strong>The questionnaire was successfully translated and culturally adapted into Italian, French, and German, maintaining its conceptual integrity and high comprehensibility. The Swiss UCAP-Q provides healthcare professionals with a standardized, multilingual tool to support active case-finding of individuals at risk of asthma and COPD.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emphysema treatment gap and gender differences in a lung cancer screening cohort.","authors":"Sara Elatris, Charlotte Besson, Isabelle Pitrou, Benjamin M Smith, Abhinav Sharma, Jean Bourbeau, Robyn Tamblyn, Roland Grad, Andrea Benedetti, Simon Martel, François Maltais, Emily McDonald, Nicole Ezer","doi":"10.1159/res/aepag009","DOIUrl":"https://doi.org/10.1159/res/aepag009","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is a unique opportunity to improve diagnosis and treatment of chronic obstructive pulmonary disease (COPD) in high-risk individuals. Gender differences have been reported in the management of COPD, though inconsistently. We examined the factors associated with pharmacologic treatment of COPD among LCS participants with radiologic visual emphysema and the gender-differences in treatment and symptoms of COPD.</p><p><strong>Methods: </strong>Participants were recruited from the Quebec LCS program (smokers or ex-smokers aged 55-74 years with a PLCOm2012 ≥ 2%) between April 2023 and July 2024 A LCS cohort was constituted from LCS participants with any level of visual emphysema on their LDCT scans and defined as having probable COPD. Primary outcome was pharmacological treatment for probable COPD defined as self-reported use of long-acting bronchodilators. Participants were screened for respiratory symptoms with the modified Medical Research Council (mMRC) and the COPD Assessment Test (CAT) scales. Probable symptomatic COPD was defined as visual emphysema on LDCT scan with mMRC score ≥ 1 and/or CAT score ≥ 10. Logistic regression was used to identify factors associated with the likelihood of pharmacologic treatment for probable COPD, including gender, sociodemographic variables, radiologic emphysema severity, smoking, and body mass index. Gender-based differences in pharmacotherapy and symptoms were further examined using stratified analyses in males and females.</p><p><strong>Results: </strong>Among 1026 participants undergoing LCS, 801 (78%) had visual emphysema of any level on LDCT, with 75% (603/801) of these lacking pharmacological treatment for probable COPD. Males were more likely to lack pharmacological treatment compared to females (58% vs. 42%). In multivariable analysis, the factors associated with treatment for probable COPD were female gender (OR 1.58; 95% CI: 1.11-2.24), and moderate-to-severe emphysema (OR 2.36; 95%CI: 1.64-3.41). Among participants screened for respiratory symptoms (397/603), 56% (221/397) were symptomatic (mean CAT=12.6 and mMRC score=0.91). Females (111/174; 64%) reported more symptoms than males (110/223; 49%), particularly for minimal-to-mild emphysema: mean CAT=10.3 and mMRC=0.62 vs. mean CAT=8.2 and mMRC=0.41.</p><p><strong>Conclusion: </strong>Lack of pharmacological treatment was frequent among LCS participants with symptomatic radiologic emphysema. Lack of treatment was associated with male gender, and a lesser degree of radiologic emphysema. Females reported more symptoms for milder emphysema. Integrating respiratory diagnosis within LCS programs is an important opportunity to leverage the LDCT results and raise clinical suspicion of individuals with COPD. Raising awareness on the gender differences in pharmacological treatments is essential to close the treatment gap in COPD.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-Hospital Intensive Care in Germany: who's out there? Key Issues Revealed by the Clinical Application of the New Legislation in Baden Württemberg.","authors":"Biljana Joves, Axel Kempa, Andreas Rheinhold, Benjamin Neetz, Felix J F Herth, Franziska C Trudzinski","doi":"10.1159/res/aepag011","DOIUrl":"10.1159/res/aepag011","url":null,"abstract":"<p><strong>Introduction: </strong>Against the background of 20,000+ patients in need of out-of-hospital intensive care in Germany, the new legislation aims to optimize medical care and strengthen the rehabilitation potential in this vulnerable group, including the stipulation that intensive care must be prescribed and optimized by doctors experienced in intensive care. The present study aims to present the first results of this intervention.</p><p><strong>Methods: </strong>Respiratory physician and therapist from Loewenstein Weaning Center examined 148 consecutive adult patients between October 2023 and February 2026 and evaluated their weaning potential. The patient-history data were analyzed retrospectively. Descriptive statistics were used to describe the patients' demographic characteristics and clinical profile, indication for intensive care, weaning potential and the results of subsequent weaning/decannulation attempts.</p><p><strong>Results: </strong>A total of 148 consecutive patients were evaluated: 140 (94.6%) on-site and 8 (5.4%) telemedically. 69 (46.6%) resided in specialized respiratory-care communities, 71 (48.0%) in nursing homes, and 8 (5.4%) at home. The mean age was 61.2 ± 13.2 years, and 111 (75.0%) patients were male. Tracheostomy was present in 138 (93.2%) patients, of whom 34 (24.6% of the tracheostomized cohort; 23.0% of the total population) were also invasively ventilated. 10 (6.8%) patients used noninvasive ventilation. Neurological impairment (primary or secondary) led to tracheostomy in 106 (76.8%) patients, while the second leading cause was pulmonary disease in 18 (13.0%) patients. Of the invasively ventilated patients, 6/34 (17.6%) were successfully weaned. A total of 47/138 (34.1%) patients had short- or long-term decannulation potential. Specifically, 19/138 (13.8%) patients with short-term potential were successfully decannulated (including the 6 previously weaned patients), and 28/138 (20.3%) patients with long-term potential were referred for neurological rehabilitation. Following re-evaluation, 3/10 (30.0%) noninvasively ventilated patients no longer required out-of-hospital intensive care.</p><p><strong>Conclusion: </strong>Only a quarter of out-patients requiring intensive care are invasively ventilated. Adequate care for ventilated patients should be coordinated by weaning centers in order to exploit the existing weaning potential. Access to rehabilitation is a decisive factor in maximizing the long-term decannulation potential.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomised, controlled trial on fluid restriction in pulmonary arterial hypertension.","authors":"Nicola Benjamin, Vera Hess, Panagiota Xanthouli, Carolin Resag, Benjamin Egenlauf, Jonathan Heinz, Ekkehard Grünig, Satenik Harutyunova","doi":"10.1159/res/aepag008","DOIUrl":"https://doi.org/10.1159/res/aepag008","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to analyse the influence of fluid restriction (FR) on right heart size and clinical parameters in pulmonary arterial hypertension (PAH) patients with right heart failure (RHF).</p><p><strong>Methods: </strong>In this prospective, single-centre, randomised, controlled study (Trial Registration: DRKS00029667), PAH patients with RHF and signs of volume overload were included. Intensified instructions for restriction of fluid intake to ≈1.5 l/d were compared to routine recommendation of FR. The primary endpoint was the change in right atrial (RA) and right ventricular (RV) area at follow-up. Secondary endpoints included haemodynamics, quality of life, symptoms and physical capacity.</p><p><strong>Results: </strong>Overall, 41 PAH patients were included (70.2±12.0 years; 51.2% male; 70.7% WHO functional class III). During follow-up (mean 28.0±6.4 weeks) both groups showed comparable fluid intake reduction (intervention -0.56±0.51 l/d; control -0.57±0.71 l/d; all -0.57±0.60 l/d; p<0.001) with a significant improvement of the primary endpoint RA area (mean reduction -2.09±5.88 cm²; p=0.049) but not RV area (-1.12±4.48 cm²; p=0.160). Among secondary endpoints systolic pulmonary arterial pressure (sPAP, -7.90±14.68 mmHg; p=0.005), left ventricular eccentricity index (LV-EI, -0.09±0.22; p=0.020), mental health (6.67±18.57; p=0.047), physical function (8.03±20.04; p=0.028) and symptom burden (PAH-SYMPACT -4.33±10.23; p=0.021) improved significantly.</p><p><strong>Conclusion: </strong>The results of this controlled, prospective study demonstrate that FR to ≈1.5 l/d can significantly improve RA size and important clinical parameters in PAH patients as sPAP, LV-EI and quality of life. Notably, routine clinical counselling alone was sufficient to achieve effective fluid restriction, with no additional benefit observed from an intensified educational intervention.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional clinical deterioration in interstitial lung disease: longitudinal concordance of frailty, patient-reported outcomes, and lung function in a multinational European registry cohort study.","authors":"Silke Tello, Anita C Windhorst, Heva Mustafa, Poornima Mahavadi, Juergen Behr, Bruno Crestani, Carlo Vancheri, Maria Molina-Molina, Andreas Günther, Ekaterina Krauss","doi":"10.1159/res/aepag007","DOIUrl":"https://doi.org/10.1159/res/aepag007","url":null,"abstract":"<p><strong>Background: </strong>In interstitial lung disease (ILD), progression is tracked along lung physiology, patient-reported outcomes (PROMs), and frailty, and prior registries report that these dimen-sions correlate at the group level. Whether deterioration on one axis identifies the same indi-vidual patients as another has not been examined.</p><p><strong>Methods: </strong>In 371 adults from the multinational European ILD Registry (eurILDreg), spanning the full ILD spectrum, baseline-to-last-visit change was classified as decline at the minimal clinically important difference across eight instruments (CFS, MRC dyspnoea, K-BILD, LCQ, EQ-5D-5L, cough VAS, FVC %pred, DLCO %pred). Patient-level agreement was quantified by Cohen's κ, interpreted direction-sensitively; a pre-specified window-matched analysis was primary because instrument follow-up windows differed (analysis-specific n 127 to 178). Outcomes (death or lung transplantation) were ascertained in 312 patients (24 events).</p><p><strong>Results: </strong>At the individual-patient level, frailty, PROMs, and lung function deteriorated in largely different patients: window-matched agreement was no better than chance for every primary pair (CFS×K-BILD 0.10, CFS×FVC -0.07, K-BILD×FVC 0.28). No pair of the eight instruments reached even moderate agreement (maximum κ=0.33), and the discordance was not explained by measurement timing, diagnostic heterogeneity (persisting within IPF, κ 0.07 to 0.26), or a single domain - the two ILD PROMs themselves disagreed (K-BILD×LCQ κ=-0.19). Physiological (FVC-defined) progression independently predicted K-BILD decline (OR 5.03). A spirometry-invisible subgroup declining on K-BILD while FVC remained stable (22% of 134) carried the highest event rate (13.3%).</p><p><strong>Conclusion: </strong>In interstitial lung disease, deterioration in frailty, patient-reported outcomes, and lung physiology identified largely non-overlapping populations at the level of the individual patient, with low agreement even within the patient-reported domain. Because subgroup with declining patient-reported outcomes but preserved spirometry showed the highest event rate, assessment based on any single measure, and on forced vital capacity in particular, may not capture all deteriorating patients. These findings support the integration of validated patient-reported outcomes and frailty measures into multidimensional assessment, and indicate that prospective validation of multi-axis decline against clinical outcomes should inform future ILD research and the design of progression criteria.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tidal Volume in Idiopathic Pulmonary Fibrosis: Restriction Severity and Prognostic Information beyond Forced Vital Capacity.","authors":"Ekaterina Krauss, Silke Tello, Til K Spreuer, Katharina Wendlandt, Ayca Tunay, Poornima Mahavadi, Carlo Vancheri, Maria Molina Molina, Bruno Crestani, Andreas Günther","doi":"10.1159/000553631","DOIUrl":"10.1159/000553631","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic pulmonary fibrosis (IPF) is characterised by progressive loss of lung compliance, which raises the elastic work of breathing and alters resting ventilatory strategy. Clinical assessment of IPF still relies on forced manoeuvres, particularly forced vital capacity (FVC), which capture maximal performance rather than this resting adaptation. How tidal volume (VT) evolves over the IPF course is not well characterised. VT and the VT/FVC ratio offer an effort-independent window onto the same physiology, characterised here longitudinally.</p><p><strong>Methods: </strong>We analysed 613 IPF patients enrolled at 3 European eurIPFreg centres (Giessen, Barcelona, Paris) between 2009 and 2025. Baseline VT, FVC, and VT/FVC were compared between survivors and non-survivors. Transplant-free survival was analysed by Cox regression, including age, sex, antifibrotic treatment, log-transformed VT and FVC, and their interaction. Discrimination was assessed by Harrell's C index with 20-fold cross-validation and time-dependent AUCs. Longitudinal trajectories were modeled over 60 months.</p><p><strong>Results: </strong>VT followed a dynamic, non-monotonic trajectory consistent with progressive ventilatory adaptation, rising transiently to ∼5% above baseline at months 18-21, coincident with the steepest segment of FVC decline (months: 6-18), and returning slowly toward baseline thereafter. The VT/FVC ratio rose continuously (+17% at 60 months), the only marker to evolve monotonically, while FVC declined progressively (-8.8%). Higher baseline VT showed a trend toward improved survival (log-rank p = 0.092; hazard ratio [HR]: 0.88, 95% CI: 0.75-1.04), and the VT/FVC ratio stratified survival significantly (log-rank p < 0.001), as did baseline FVC (HR: 0.59 per unit log-FVC, 95% CI: 0.49-0.69; p < 0.001). The VT × FVC interaction approached significance (HR: 1.12, 95% CI: 0.98-1.30; p = 0.08), suggesting a joint physiological signal. Antifibrotic therapy reduced mortality (HR: 0.63, 95% CI: 0.50-0.81; p < 0.001).</p><p><strong>Conclusion: </strong>VT in IPF follows a dynamic, non-monotonic course, rising during the steepest phase of FVC decline and returning toward baseline thereafter, consistent with a ventilatory adaptation in which increased VT serves as a transient lower cost strategy for maintaining minute ventilation before the elastic load makes it unsustainable. The VT/FVC ratio integrates this rising drive with falling vital capacity, evolves monotonically, and stratifies survival, identifying it as an effort-independent physiological descriptor of restrictive remodelling. Together, VT and VT/FVC enrich the standard FVC-based assessment of IPF by capturing the resting ventilatory dimension of disease progression.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-14"},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Pulmonary Arterial Hypertension and Heart Failure with Preserved Ejection Fraction as Cardiovascular Comorbidity.","authors":"Satenik Harutyunova, Andreea E Florea, Nicola Benjamin, Christina A Eichstaedt, Benjamin Egenlauf, Lena Brückner, Julia Szendroedi, Michael Preusch, Ekkehard Grünig, Panagiota Xanthouli","doi":"10.1159/res/aepag005","DOIUrl":"10.1159/res/aepag005","url":null,"abstract":"<p><strong>Introduction: </strong>The clinical phenotype of pulmonary arterial hypertension (PAH) has shifted increasingly toward older patients with more cardiovascular comorbidities. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are used to treat symptomatic chronic heart failure. This study aimed to evaluate the impact of add-on SGLT2i in PAH patients with heart failure with preserved ejection fraction (HFpEF) as comorbidity.</p><p><strong>Methods: </strong>PAH patients on stable therapy receiving SGLT2i as add-on were included in this single-center, retrospective cohort study. The primary endpoint comprised the change in echocardiographic right atrial (RA) area and right ventricular (RV) function after treatment with SGLT2i. Further clinical and echocardiographic parameters were analyzed.</p><p><strong>Results: </strong>In total, 198 patients on stable PAH therapy for at least 3 months receiving SGLT2i treatment and available follow-up assessments were analyzed (74 ± 28 years, 61% female; 83.9% WHO functional class III-IV). During SGLT2i treatment, a significant reduction in RA area (-1.93 ± 4.45 cm2) (p < 0.001) and improvement in RV function (p < 0.001) during the mean follow-up of 6.7 ± 3.3 months could be detected. RV area (-1.69 ± 4.83 cm2), left atrial diameter (-2.17 ± 4.43 mm), and systolic pulmonary arterial pressure (-9.26 ± 16.10 mm Hg) decreased significantly (all p < 0.001). The mean 6-min walking distance increased by 51.68 ± 58.5 m (p < 0.001) and risk stratification significantly improved. Five patients discontinued the medication due to side effects.</p><p><strong>Conclusion: </strong>In patients with PAH and HFpEF as comorbidity, SGLT2i as add-on to targeted therapy significantly improved right heart size and function, as well as further clinical parameters, and was well tolerated. Further prospective studies are necessary to confirm these results.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Applications in Radiology: The New Frontier in Interstitial Lung Diseases.","authors":"Linrui Xu, Ruizhi Wang, Min Zhu, Fengming Luo","doi":"10.1159/res/aepag001","DOIUrl":"10.1159/res/aepag001","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung disease (ILD) comprises a heterogeneous group of disorders with diverse clinical behaviors, for which early diagnosis, accurate risk stratification, and timely intervention remain challenging. High-resolution computed tomography plays a pivotal role in ILD evaluation; however, conventional visual interpretation is limited by subjectivity and inter-observer variability. Recent advances in artificial intelligence (AI), particularly deep learning, have created new opportunities to improve imaging-based assessment throughout the ILD care pathway.</p><p><strong>Summary: </strong>This review summarizes current applications of AI in ILD, with a focus on early detection, diagnostic classification, prognostic assessment, and longitudinal monitoring. AI-driven imaging analysis can enhance the identification of subtle interstitial abnormalities, improve classification of radiologic patterns, and generate quantitative biomarkers associated with disease severity and progression. Emerging multimodal models integrating imaging, clinical, and functional data may further refine risk stratification and support individualized management. Despite these advances, important barriers to widespread clinical implementation remain, including limited external validation, poor interpretability, data heterogeneity, and uncertain impact on patient-centered outcomes.</p><p><strong>Key messages: </strong>AI is reshaping the role of thoracic imaging in ILD from descriptive interpretation toward quantitative and decision-supportive analysis. It also has the potential to optimize multidisciplinary discussion and improve efficiency in routine clinical workflows. To facilitate translation into clinical practice, future efforts should prioritize prospective validation, multimodal integration, and clinically meaningful implementation.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}