Respiratory medicine最新文献

{"title":"Characterisation of patients with Alpha-1 antitrypsin deficiency using unsupervised machine learning tools","authors":"Laura Villar-Aguilar ,&nbsp;Manuel Casal-Guisande ,&nbsp;Alberto Fernández-Villar ,&nbsp;Esmeralda García-Rodríguez ,&nbsp;Ana Priegue-Carrera ,&nbsp;Marc Miravitlles ,&nbsp;María Torres-Durán","doi":"10.1016/j.rmed.2025.108278","DOIUrl":"10.1016/j.rmed.2025.108278","url":null,"abstract":"<div><h3>Background</h3><div>Alpha-1 antitrypsin deficiency (AATD) is an underdiagnosed and clinically heterogeneous genetic disorder that increases the risk of pulmonary emphysema and liver disease. Its management is complex due to high individual variability, which hinders risk stratification and personalised treatment. Artificial Intelligence (AI), particularly Machine Learning (ML) techniques, may offer novel approaches to the clinical characterisation of AATD.</div></div><div><h3>Materials and methods</h3><div>A pilot, single-centre cross-sectional study was conducted, including 210 AATD patients from the EARCO registry at Álvaro Cunqueiro Hospital (Vigo, Spain), between February 2020 and June 2023. The unsupervised k-prototypes algorithm was applied to identify clusters based on clinical and demographic variables. Functional and clinical differences among clusters were analysed using Mann-Whitney U and Chi-square tests, with p &lt; 0.05 considered significant. This pilot study, based on a regional cohort with high Pi∗SZ prevalence, explores the feasibility of applying AI in clinical practice without aiming to represent the full EARCO registry.</div></div><div><h3>Results</h3><div>Five clinically distinct clusters were identified: A) Pi∗ZZ patients with emphysema and severe functional impairment; B) women with bronchiectasis and preserved pulmonary function; C) young asymptomatic individuals with the Pi∗SZ genotype; D) older patients with COPD and cardiovascular comorbidities; E) individuals with altered hepatic profiles, alcohol consumption, and moderate AATD. Significant differences in pulmonary function, AAT levels, and comorbidities were observed.</div></div><div><h3>Conclusions</h3><div>This pilot study shows the feasibility of using ML to segment AATD patients into meaningful clusters, adding value for personalised medicine. This approach may guide therapeutic decisions, improve follow-up, and support the design of cluster-based multicentre trials.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108278"},"PeriodicalIF":3.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739202","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":"Molecular mechanisms of passive smoking-induced respiratory diseases","authors":"Hina Agraval ,&nbsp;Umesh C.S. Yadav","doi":"10.1016/j.rmed.2025.108279","DOIUrl":"10.1016/j.rmed.2025.108279","url":null,"abstract":"<div><div>Cigarette smoke, including second hand and third hand smokes, is a well-established risk factor for respiratory diseases, and accounts for one in five deaths in the United States annually. Passive smoking involves second hand smoke (SHS) and third hand smoke (THS) that contain the similar carcinogenic compounds, oxidants and toxicants that are present in mainstream smoke (MS) such as formaldehyde, acrolein, aromatic amines, polycyclic aromatic hydrocarbons (PAHs), and various inorganic substances. SHS particles are smaller than those in MS, enabling them to reach the distal regions of the lungs. These toxic chemicals are considerably deleterious to lungs’ health and cause serious respiratory diseases. The inhaled toxicants in SHS and THS directly damage airway epithelial cells of the lungs, leading to oxidative stress, inflammation and tissue damage, and interfere with cellular repair mechanisms leading to mucociliary dysfunction, thereby exacerbating chronic inflammatory responses. The molecular mechanisms associated with SHS exposure include DNA adduct formation, epigenetic modifications of the genes and altered signaling mechanisms leading to lung dysfunction. These changes are irrespective of age or gender, and raise significant concerns regarding long-term pathological consequences of exposure to passive smoke. Here we have reviewed the major molecular pathways that play crucial roles in manifesting the lung pathogenesis related to passive smoking.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108279"},"PeriodicalIF":3.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738014","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":"Ventilator-associated pneumonia: mechanisms, an appraisal of current therapies and the role for inhaled antibiotics in prevention and treatment","authors":"Fiona Howroyd ,&nbsp;Rebecca Gill ,&nbsp;Jamie Thompson ,&nbsp;Fang Gao Smith ,&nbsp;Prashant Nasa ,&nbsp;Shameer Gopal ,&nbsp;Niharika A. Duggal ,&nbsp;Zubair Ahmed ,&nbsp;Tonny Veenith","doi":"10.1016/j.rmed.2025.108275","DOIUrl":"10.1016/j.rmed.2025.108275","url":null,"abstract":"<div><div>Ventilator-associated pneumonia (VAP) is the most prevalent nosocomial infection in the intensive care unit (ICU), accounting for more than 30 % of the overall costs for all healthcare-associated infections. VAP leads to poor outcomes, such as increased duration of mechanical ventilation, prolonged length of ICU stay and increased mortality rates for up to five years after discharge. The pathophysiology of VAP is complex, attributable to the colonisation of abnormal microbiota and micro-aspiration risks associated with mechanical ventilation and critical illness, and thus its prevention and treatment is complex. With the rising prevalence of multidrug resistance infections and antibiotic prescription pressures, the management of VAP is becoming increasingly challenging. The traditional treatment of VAP with intravenous or oral antibiotics is effective; yet inhaled antibiotics may offer a targeted, synergistic and effective alternative. Empirical therapy with broad-spectrum antibiotics are associated with systemic complications and increased pathogenic strains, whilst inhaled antibiotics reduce bystander antimicrobial resistance with fewer systemic side effects. However, large-scale clinical trials have failed to cosnsitently demonstrate the clinical benefits of inhaled antibiotics and thus translation into practice remains controversial. In this review, we summarise the pathophysiology and diagnosis of VAP, underpin the mechanisms of currently available therapies and discuss the potential role of inhaled antibiotics for the prevention and treatment of VAP, with critical discussion of the available evidence.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108275"},"PeriodicalIF":3.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722782","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":"High-intensity versus low-intensity non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis","authors":"Haniya Shahid,&nbsp;Muhammad Ahmed,&nbsp;Syeda Zuha Sami,&nbsp;Sanjeet Kumar,&nbsp;Javeria Farooq,&nbsp;Ilsa Asif,&nbsp;Zainab Muhammad Hanif,&nbsp;Ariba Nazir","doi":"10.1016/j.rmed.2025.108277","DOIUrl":"10.1016/j.rmed.2025.108277","url":null,"abstract":"<div><h3>Background</h3><div>Non-invasive positive pressure ventilation (NIPPV) is a key treatment for acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). This meta-analysis compares high-versus low-intensity NIPPV.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across major databases. Studies comparing high- and low-intensity NIPPV in AECOPD were included. Statistical analysis-using RevMan, statistical significance set at p &lt; 0.05, risk ratio for dichotomous data, while mean difference for continuous data with 95 % CI via random effect model, and Higgins I² to measure heterogeneity was carried out following PRISMA guidelines.</div></div><div><h3>Results</h3><div>Four studies, which consisted of 618 patients, were analyzed. Primary outcomes were intubation need and short-term mortality. Secondary outcomes included PaCO₂ at 48 and 72 h and abdominal distension. High-intensity NIPPV significantly reduced short-term mortality (RR: 0.43, CI: [0.22, 0.85], P = 0.02) but had no significant effect on intubation rates. PaCO₂ levels at 48 and 72 h showed no significant difference. Abdominal distension was more common in the high-intensity group (RR: 1.49, P = 0.02).</div></div><div><h3>Conclusion</h3><div>High-intensity NIPPV lowers short-term mortality but increases abdominal distension. Further studies are needed.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108277"},"PeriodicalIF":3.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712918","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":"Impaired respiratory and functional capacity in individuals with sleep BRUXISM: A controlled cross-sectional study","authors":"Sevim Beyza Olmez ,&nbsp;Melek Volkan-Yazici ,&nbsp;Gokhan Yazici ,&nbsp;Merve Önder ,&nbsp;Cengiz Evli ,&nbsp;Nevin Atalay Güzel ,&nbsp;Kaan Orhan ,&nbsp;Nihan Karatas","doi":"10.1016/j.rmed.2025.108272","DOIUrl":"10.1016/j.rmed.2025.108272","url":null,"abstract":"<div><h3>Background</h3><div>Growing evidence indicates that Sleep bruxism (SB) is recognized as a multifaceted condition that potentially has systemic implications, including effects on respiratory functions, exercise capacity, and possibly other body systems, which may reduce overall quality of life (QOL). This study aimed to investigate respiratory functions, respiratory muscle performance, functional capacity, and QOL in individuals with SB compared to healthy controls.</div></div><div><h3>Materials and methods</h3><div>This study included 47 individuals with probable SB and 21 healthy controls. The classification of SB was based on self-reported and/or partner-confirmed sleep-related masticatory muscle activity (2018 international consensus criteria on bruxism). Respiratory functions were assessed via spirometry, respiratory muscle strength using maximal inspiratory and expiratory pressure measurements, and respiratory endurance with an incremental threshold loading test. Functional capacity was evaluated using the 6-min walk test (6MWT), and QOL was measured using the Short Form-36 questionnaire.</div></div><div><h3>Results</h3><div>Compared to healthy controls, individuals with SB showed significantly lower peak expiratory flow (p &lt; 0.001), maximal inspiratory and expiratory pressures (p &lt; 0.001), and respiratory muscle endurance (p &lt; 0.001). They also demonstrated reduced walking distance during the 6MWT and lower predicted percentage values (p &lt; 0.05). Additionally, QOL scores were significantly lower in physical functioning, vitality, emotional wellbeing, and general health (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study highlights that probable SB may be associated with reduced respiratory muscle performance, diminished functional capacity, and lower QOL. These findings emphasize the importance of considering systemic evaluations, particularly of respiratory and physical function, in the clinical management of SB.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108272"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704215","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":"Early human albumin infusion was associated with 28-day mortality in patients with acute respiratory failure and hypoalbuminaemia in the intensive care unit: a retrospective study of the MIMIC-IV database","authors":"Fanrong Lin ,&nbsp;Dawei Xu ,&nbsp;Junpeng Tang ,&nbsp;Teng Huang ,&nbsp;Jinzhao Zhang ,&nbsp;Li Li ,&nbsp;Zhengfei Yang","doi":"10.1016/j.rmed.2025.108273","DOIUrl":"10.1016/j.rmed.2025.108273","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the relationship between different timing of human albumin infusion and mortality in patients with acute respiratory failure in an Intensive Care Unit (ICU).</div></div><div><h3>Methods</h3><div>This cohort study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV 2.0) database. Patients were categorized into two groups, early human albumin infusion (infusion within 72 h after ICU admission) and late human albumin infusion (infusion more than 72 h after ICU admission), irrespective of dosage or colloid osmotic pressure. 28-day mortality and independent risk factors of mortality were measured.</div></div><div><h3>Results</h3><div>A total of 1118 patients with acute respiratory failure and hypoalbuminaemia were included in the analysis, with 471 patients in the early albumin infusion group and 647 patients in the late albumin infusion group. After PSM, 451 patients were included in each group. Kaplan–Meier analysis revealed that 28-day mortality was statistically significantly higher in the early albumin infusion group compared to the late albumin infusion group. Additionally, stratified analysis by albumin levels showed that 28-day mortality was statistically significantly higher in the early infusion group than in the late infusion group for patients with albumin levels less than 30 g/L.</div></div><div><h3>Conclusion</h3><div>The 28-day mortality of patients with acute respiratory failure who received early human albumin infusion in the ICU was higher than that of patients who received late human albumin infusion. Early albumin infusion was not associated with an improvement in the survival rate among patients with acute respiratory failure in the ICU.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108273"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704216","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":"Ampicillin-sulbactam versus third-generation cephalosporins in aspiration Pneumonia: A nationwide retrospective cohort study","authors":"Jumpei Taniguchi ,&nbsp;Shotaro Aso ,&nbsp;Hiroki Matsui ,&nbsp;Kiyohide Fushimi ,&nbsp;Hideo Yasunaga","doi":"10.1016/j.rmed.2025.108276","DOIUrl":"10.1016/j.rmed.2025.108276","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to evaluate the clinical outcomes of ampicillin-sulbactam versus third-generation cephalosporins (e.g., ceftriaxone or cefotaxime) in managing aspiration pneumonia.</div></div><div><h3>Methods</h3><div>We utilized the Diagnosis Procedure Combination (DPC) database, a comprehensive national inpatient database in Japan, to identify patients diagnosed with aspiration pneumonia between July 2010 and March 2022. Patients were categorized into two groups based on their treatment: those receiving ampicillin-sulbactam and those receiving third-generation cephalosporins (either ceftriaxone or cefotaxime). To mitigate confounding factors, propensity score overlap weighting analysis was employed to compare in-hospital mortality rates and the incidence of <em>Clostridioides difficile</em> infection between the two treatment groups.</div></div><div><h3>Results</h3><div>Among the 548,972 eligible patients, 424,446 received ampicillin-sulbactam, while 124,526 were treated with third-generation cephalosporins. In the third-generation cephalosporin group, 97.7 % of patients were administered ceftriaxone, and 2.3 % received cefotaxime. The mean treatment duration was 8.5 days (standard deviation [SD] 4.3) in the ampicillin-sulbactam group and 7.9 days (SD 4.1) in the third-generation cephalosporin group. Propensity score overlap weighting analysis revealed that patients treated with ampicillin-sulbactam had significantly lower in-hospital mortality (14.6 % vs. 16.4 %; risk difference [RD], −1.8 %; 95 % confidence interval [CI], −2.1 % to −1.5 %; P &lt; 0.001) and a lower incidence of <em>C. difficile</em> infection (2.0 % vs. 2.8 %; RD, −0.8 %; 95 % CI, −0.9 % to −0.7 %; P &lt; 0.001) compared to those treated with third-generation cephalosporins.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that ampicillin-sulbactam was associated with lower in-hospital mortality and a reduced incidence of <em>C. difficile</em> infection compared to third-generation cephalosporins in patients with aspiration pneumonia.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108276"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712917","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":"Exploring the genetic effects of exposure to hazardous workplaces on the risk of respiratory disease by two-sample mendelian randomization and bioinformatics analysis","authors":"Chao Wang ,&nbsp;Xiao Yu ,&nbsp;Xiaoping Guo ,&nbsp;Xin Yu ,&nbsp;Fang Wang","doi":"10.1016/j.rmed.2025.108271","DOIUrl":"10.1016/j.rmed.2025.108271","url":null,"abstract":"<div><h3>Background</h3><div>Harsh workplace can include very cold, hot, and dusty workplaces, as well as exposure in the workplace with chemicals and other fumes, cigarette smoke, and diesel exhaust. There is a shortage of genetic evidence regarding the impact of harsh workplaces on respiratory health.</div></div><div><h3>Objective</h3><div>This study aims to investigate the genetic association between harsh workplace and respiratory diseases.</div></div><div><h3>Methods</h3><div>This study used two-sample Mendelian randomization analysis based on UK Biobank, FinnGen Project, and IEU Open GWAS Database to exclude confounding factors and investigate the association between workplace and respiratory diseases.</div></div><div><h3>Results</h3><div>Frequent exposure to workplace with cigarette smoke increased the risk of allergic rhinitis (β_IVW = 1.83, <em>P</em> = 0.022). Intermittent exposure to extremely cold workplaces exacerbated asthma (β_IVW = 0.34, P = 0.011) and COPD (β_IVW = 0.80, <em>P</em> = 0.002). Rare (β_MR = 1.15, <em>P</em> = 0.037) or intermittent exposure (β_IVW = 0.59, <em>P</em> = 0.019) to extremely hot workplaces may worsen COPD. Chemical/smoke exposure may aggravate emphysema (β_IVW = 0.03, <em>P</em> = 0.016). Exposure to extremely hot (β_IVW = 0.90, <em>P</em> = 0.016) and dusty workplaces (β_IVW = 0.97, <em>P</em> = 0.005) increased lung cancer risk. Exposure to extremely cold workplaces was associated with pneumoconiosis (β_IVW = 3.99, P = 0.028) and was a significant risk factor for IPF (β_IVW = 3.28, <em>P</em> = 0.015). Rare (β_IVW = 1.69, <em>P</em> = 0.011) or frequent exposure (β_IVW = 1.44, <em>P</em> = 0.013) to dusty workplaces increased tuberculosis risk.</div></div><div><h3>Conclusions</h3><div>Our study excluded other confounding factors and revealed a causal relationship between harsh workplaces and respiratory disease from genetic inheritance. Incorporating genetic evidence into occupational health assessments helps accurately identify high-risk individuals, develop personalized intervention plans, and enhance the effectiveness of respiratory health protection for workers.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108271"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712916","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":"Association between initial treatment response and prognosis in acute exacerbations of idiopathic pulmonary fibrosis treated with steroid pulse therapy","authors":"Tsuyoshi Sasada,&nbsp;Chigusa Shirakawa,&nbsp;Kazuma Nagata,&nbsp;Katsuyuki Furuta,&nbsp;Ryosuke Hirabayashi,&nbsp;Yuki Sato,&nbsp;Atsushi Nakagawa,&nbsp;Keisuke Tomii,&nbsp;Ryo Tachikawa","doi":"10.1016/j.rmed.2025.108269","DOIUrl":"10.1016/j.rmed.2025.108269","url":null,"abstract":"<div><h3>Background</h3><div>Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) critically affects patient survival. This study aimed to determine whether an early treatment response could accurately predict prognostic outcomes in patients with AE-IPF.</div></div><div><h3>Methods</h3><div>This retrospective cohort study conducted at Kobe City Medical Centre General Hospital analysed 100 patients with AE-IPF treated with steroid pulse therapy during January 2012–December 2021. The initiation day was defined as Day 1. Patients were classified into Responder or Non-Responder groups based on the changes in peripheral capillary oxygen saturation/fraction of inspired oxygen (S/F) ratios from Days 1–4. The primary outcome was 28-day mortality. Cox proportional hazards models assessed the association between 28-day mortality and potential prognostic factors, including age, KL-6 levels, S/F ratios on Day 1, and Responder group status.</div></div><div><h3>Results</h3><div>The study cohort included 60 and 40 patients in the Responder and Non-Responder groups, respectively. The Responder group has significantly higher median IgG levels (1519 mg/dL vs. 1014 mg/dL) and lower mortality rates (12 % vs. 42.5 % at 28 days). On Day 1, the S/F ratios were comparable between the two groups. Similarly, age and levels of Krebs von den Lungen-6 also showed no significant differences. Multivariable Cox proportional hazards analysis revealed that higher initial S/F ratios (HR: 0.18, 95 % CI: 0.06–0.52) and classification in the Responder group (HR: 0.22, 95 % CI: 0.10–0.53) were associated with lower 28-day mortality.</div></div><div><h3>Conclusion</h3><div>Early improvements in S/F ratios may indicate improved survival in patients with AE-IPF, suggesting their potential importance in early therapeutic decisions.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108269"},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703109","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":"Probiotics: An adjuvant treatment strategy for chronic respiratory diseases","authors":"Bharti Verma ,&nbsp;Nitish Kumar ,&nbsp;Sumel Ashique ,&nbsp;Biplab Debnath ,&nbsp;Ashish Garg ,&nbsp;Neeraj Mishra ,&nbsp;Naheed Mojgani ,&nbsp;Monika Kaurav ,&nbsp;Madhu Gupta ,&nbsp;Mithun Bhowmick ,&nbsp;Farzad Taghizadeh-Hesary","doi":"10.1016/j.rmed.2025.108268","DOIUrl":"10.1016/j.rmed.2025.108268","url":null,"abstract":"<div><div>Chronic respiratory disease is considered by reduced airflow and heightened airway inflammation, a pattern that has progressively increased in past few decades. Currently, chronic respiratory disease is considered one of the main leading causes of death worldwide. The gut-lung axis, which connects these two organs, facilitates bidirectional communication and may be influenced by microbiome populations in the context of disease interactions. The human microbiome, particularly in the gastrointestinal tract is thought to play a pivotal role in affecting diseases and maintaining homeostasis. Dysbiosis, defined as an imbalance in the gut microbiota, is associated with an elevated risk of lung infections. Studies have shown that modifying the gut microbiota by the use of probiotics, prebiotics, and synbiotics can reduce the duration and extent of respiratory infections. Probiotics have been observed to significantly alter serum cytokine and IgE levels in allergic conditions, as well as reduce eosinophilia in individuals with asthma. However, there has been no discernible improvement in clinical symptoms, although this approach may diminish eosinophilia in chronic obstructive pulmonary disease (COPD) patients and mitigate serum cytokine and IgE levels. Several factors such as illness severity, treatment duration, patient-specific, environmental characteristics, and treatment regimen seem to influence the effectiveness of these interventions. Research indicates that direct interaction and colonization of respiratory epithelial cells by probiotic microbes can enhance the success of intranasal probiotic delivery compared to oral administration. Although allergic rhinitis is a chronic inflammatory ailment, nasal probiotics have been utilized to address acute infections and respiratory disorders, offering a promising therapeutic avenue for a range of chronic inflammatory conditions.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"247 ","pages":"Article 108268"},"PeriodicalIF":3.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703108","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}