Respiratory medicine最新文献

{"title":"MHR as a promising predictor for coronary artery disease in COPD patients: Insights from a retrospective nomogram study","authors":"Feng Sun ,&nbsp;Mei Ye ,&nbsp;Ayididar Jumahan ,&nbsp;Aidibai Aainiwaier ,&nbsp;Yu Xia","doi":"10.1016/j.rmed.2025.107993","DOIUrl":"10.1016/j.rmed.2025.107993","url":null,"abstract":"<div><h3>Background and objective</h3><div>Chronic obstructive pulmonary disease (COPD) frequently co-occurs with coronary artery disease (CAD), adversely affecting patients morbidity and mortality. Identifying new risk factors for CAD in COPD patients is essential for improving clinical management and patients outcomes.</div></div><div><h3>Methods</h3><div>This retrospective case-control study analyzed 406 COPD patients who underwent coronary artery computed tomography angiography (CCTA). Patients were categorized into co-CAD and non-CAD groups based on CCTA findings. Demographic and laboratory data were assessed to determine independent risk factors for CAD in COPD patients using univariate and multivariate logistic regression analyses.</div></div><div><h3>Results</h3><div>The co-CAD group was significantly older, had a higher prevalence of males, and included a higher proportion of individuals with hypertension, diabetes, cardiovascular diseases, as well as cerebrovascular diseases, exhibiting lower FEV1 values (P &lt; 0.05). This group also exhibited higher levels of HbA1c, IL-6, monocyte count, and MHR (P &lt; 0.05). Multivariate logistic regression identified age, hypertension, and MHR as independent predictors of CAD. A nomogram incorporating these predictors demonstrated robust predictive accuracy with an area under the ROC curve of 0.758 (95 % CI: 0.704–0.814), effectively stratifying patients into high and low risk for CAD.</div></div><div><h3>Conclusion</h3><div>The identification of MHR as an independent predictor of CAD in COPD patients opens new avenues for understanding cardiovascular comorbidities. The nomogram's integration of MHR with age and hypertension provides an effective tool for early CAD detection and management, promising to enhance clinical outcomes and decrease mortality rates in COPD patients. These insights may inform future preventative strategies against CAD in COPD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"239 ","pages":"Article 107993"},"PeriodicalIF":3.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414992","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":"Comparing adsorptive blood purification modalities for sepsis patients: A systematic review and network meta-analysis","authors":"Huameng Xing ,&nbsp;Yuxuan Wei ,&nbsp;Dongmei Zhang ,&nbsp;Zheng Jiang ,&nbsp;Jianhua Qin ,&nbsp;Santao Ou ,&nbsp;Weihua Wu","doi":"10.1016/j.rmed.2025.107994","DOIUrl":"10.1016/j.rmed.2025.107994","url":null,"abstract":"<div><h3>Purpose</h3><div>Hemoadsorption is a promising therapeutic modality for sepsis, however, the most effective approach is unknown. This meta-analysis aimed to compare the efficacy of different adsorptive blood purification (ABP) modalities in patients with sepsis.</div></div><div><h3>Materials and methods</h3><div>Randomized controlled trials (RCTs) investigating the clinical efficacy of ABP modalities in patients with sepsis were retrieved from English databases from inception up to October 14, 2024. The data were analyzed using Stata15 and R software. Quality assessment and publication bias were assessed using the Cochrane Risk of Bias Assessment Tool and funnel plots, respectively. The outcomes of the meta-analysis were hospital mortality, oxygenation index, ICU stay days, and blood lactate concentration.</div></div><div><h3>Results</h3><div>A total of 47 RCTs were identified, comprising 9 ABP modalities. In terms of cumulative ranking probability, the HA330 modality achieved the highest reduction in hospital mortality (99.5 %) and ICU stay days (97.2 %), whereas CPFA showed the highest reduction in oxygenation index (94.9 %) and oXiris had the highest reduction in lactate (95.7 %).</div></div><div><h3>Conclusions</h3><div>HA330 and PMX showed superior overall efficacy in sepsis patients compared with other modalities, although there was potential heterogeneity. However, further RCTs with large samples are advocated to test new approaches of hemosorption and validate the present findings.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"239 ","pages":"Article 107994"},"PeriodicalIF":3.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418943","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":"A patient journey map for people living with autoimmune pulmonary alveolar proteinosis","authors":"Ali Ataya ,&nbsp;Niki Plomaritis ,&nbsp;Michele Rhee ,&nbsp;Swaminathan Perinkulam Sathyanarayanan ,&nbsp;Brian Robinson","doi":"10.1016/j.rmed.2025.107990","DOIUrl":"10.1016/j.rmed.2025.107990","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with autoimmune pulmonary alveolar proteinosis (PAP) face a complicated journey (physically, emotionally, and financially) to receive the correct diagnosis and treatment. We developed a patient journey map (PJM) to describe the experiences and needs of patients with autoimmune PAP in the USA.</div></div><div><h3>Methods</h3><div>This PJM was developed in four stages: (1) analysis of existing literature; (2) patient advisory board meetings (n = 7); (3) an online survey (n = 19); and (4) a validation workshop (n = 6).</div></div><div><h3>Results</h3><div>Four phases of the patient journey were identified: (1) symptoms and experience before diagnosis; (2) diagnosis; (3) treatment; and (4) ongoing monitoring. Patients reported heterogeneous and indirect diagnostic pathways, often waiting months or years for the correct diagnosis. The majority reported at least one misdiagnosis, most commonly pneumonia. Treatment pathways varied substantially, and current treatments and off-label therapies were frequently described as burdensome, emotionally taxing, and/or financially worrisome. Patients described their journey as an “<em>emotional rollercoaster</em>,” especially during pre-diagnosis and treatment. Patients reported common barriers to care, particularly insurance problems and access to expert care. Patients specifically cited the need for improved education on autoimmune PAP within the medical community and increased help with insurance challenges related to current treatments.</div></div><div><h3>Conclusions</h3><div>This PJM provides insights on patients’ journeys with autoimmune PAP. Patients reported inconsistent, burdensome, and circuitous journeys. This PJM provides the medical community with valuable information on patients’ needs and increases awareness of this rare disease. Over time, these factors may improve diagnosis, treatment, and the holistic experience of patients with autoimmune PAP.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"240 ","pages":"Article 107990"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414991","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":"Outcomes in lung transplant recipients on azathioprine compared to mycophenolate","authors":"David M. Sanborn ,&nbsp;Joelle N. Friesen ,&nbsp;Hemang Yadav ,&nbsp;Cassie C. Kennedy ,&nbsp;Mark E. Wylam ,&nbsp;Steve G. Peters ,&nbsp;John P. Scott ,&nbsp;Sahar A. Saddoughi ,&nbsp;Kelly M. Pennington","doi":"10.1016/j.rmed.2025.107991","DOIUrl":"10.1016/j.rmed.2025.107991","url":null,"abstract":"<div><h3>Intro</h3><div>A three-drug immunosuppression regimen to prevent graft loss is the cornerstone of therapy following lung transplantation. Direct comparisons between maintenance regimens including mycophenolate (MMF) and azathioprine (AZA) are limited in the lung transplant population.</div></div><div><h3>Methods</h3><div>We completed a retrospective cohort study of adult (≥18 years of age) lung transplant recipients at Mayo Clinic (Rochester, MN) from January 1, 2009 through July 1, 2022 and compared outcomes in patients on AZA vs MMF. Our primary outcome was clinically significant acute cellular rejection. Secondary outcomes included graft loss, drug interruption, chronic lung allograft dysfunction (CLAD), and infection. Analyses were performed with Multivariable Cox Regression with transplant era and induction immunosuppression agent as covariables.</div></div><div><h3>Results</h3><div>224 patients were included, 88 on AZA and 136 on MMF. The risk of clinically significant rejection was greater in the AZA group compared to the MMF group (HR, 1.76; 95 % CI 1.12–2.79; <em>P</em> = 0.02). Medication interruption was also higher in the AZA (HR, 1.47; 95 % CI 1.04–2.08; <em>P</em> = 0.026). Rates of CLAD, graft loss, and infection were similar between the groups.</div></div><div><h3>Conclusion</h3><div>In this cohort, MMF was associated with lower risk of clinically significant acute cellular rejection and drug interruption when compared to AZA. Similar rates of CLAD, graft loss, and infection were observed.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"239 ","pages":"Article 107991"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410330","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":"Comparison of GLI-2021 standards with ECSC standards for static lung volume interpretation in patients with respiratory diseases","authors":"Pierre-Marie Wardyn ,&nbsp;Virginie de Broucker ,&nbsp;Thierry Perez ,&nbsp;Silvia Demoulin-Alexikova ,&nbsp;Jean-Louis Edme ,&nbsp;Sébastien Hulo","doi":"10.1016/j.rmed.2025.107988","DOIUrl":"10.1016/j.rmed.2025.107988","url":null,"abstract":"<div><h3>Background</h3><div>In 2021, the Global Lung Function Initiative (GLI) has published new reference equations for static lung volumes (GLI-2021). Many learned societies recommend the use of GLI reference values for interpreting pulmonary function tests (PFT), while pointing out the need for clinicians to be aware of the consequences for their routine practice. We aimed to compare the GLI-2021 reference values and the 1993 European Coal and Steel Community (ECSC) standards on the interpretation of static lung volume data in patients with a probable static hyperinflation or a probable restrictive ventilatory disorder.</div></div><div><h3>Methods</h3><div>We analyzed plethysmographic PFT data from 2 groups of patients: a group of patients with symptoms compatible with chronic bronchitis (CB) and a group of patients with symptoms compatible with interstitial lung disease (ILD). We investigated discrepancies in the evaluations of static lung volumes when using the ECSC vs. the GLI-2021 reference values.</div></div><div><h3>Results</h3><div>2897 sets of PFT results (including 1598 in men) were included. In the CB group, the proportion of hyperinflation was higher for both sexes with the GLI-2021 standards. In the ILD group, the proportion of restrictive ventilatory disorders was higher in women but lower in men with the GLI-2021 standards.</div></div><div><h3>Conclusion</h3><div>A move from use of the ECSC standards for static lung volumes to the GLI-2021 standards might lead to a higher estimated proportion of hyperinflation (particularly in participants with CB), together with changes in the proportion of restrictive ventilatory disorders (a lower value in men and a higher value in women with ILD).</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"239 ","pages":"Article 107988"},"PeriodicalIF":3.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391644","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":"Association between the triglyceride-glucose index and mortality in the asthma population","authors":"Pan Jiang ,&nbsp;Hongyu Lu ,&nbsp;Yichun Jiang ,&nbsp;Fanglan Li ,&nbsp;Yan Wen ,&nbsp;Changshan Wang ,&nbsp;Wenfeng Wu ,&nbsp;Feng Xu","doi":"10.1016/j.rmed.2025.107989","DOIUrl":"10.1016/j.rmed.2025.107989","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the relationship between the triglyceride-glucose (TyG) index and mortality in individuals with asthma, given the inconclusive evidence linking metabolic dysfunction to asthma outcomes.</div></div><div><h3>Research design and methods</h3><div>We analyzed data from 5985 adults with asthma from the National Health and Nutrition Examination Survey (NHANES) 2001–2018. We used multivariable weighted Cox regression, smoothing curve fitting, survival curve analysis, and subgroup analysis to assess the correlation between the TyG index and survival rates.</div></div><div><h3>Results</h3><div>A higher TyG index significantly correlated with increased all-cause mortality in asthmatics. Adjusted hazard ratios (HR) for higher TyG index categories (compared to TyG &lt;8) were: 1.69 (95 % CI: 1.28, 2.24, p &lt; 0.001) for 8 ≤ TyG &lt;9, 2.04 (95 % CI: 1.51, 2.76, p &lt; 0.001) for 9 ≤ TyG &lt;10, and 2.94 (95 % CI: 2.03, 4.28, p &lt; 0.001) for TyG ≥10. Restricted cubic spline analysis revealed a nonlinear relationship between the TyG score and mortality. Kaplan-Meier curves showed higher TyG indexes associated with greater mortality risk.</div></div><div><h3>Conclusions</h3><div>The TyG index is a significant predictor of mortality in asthma patients, highlighting its potential for risk stratification. Incorporating the TyG index into clinical assessments could improve monitoring and management. Future research should investigate interventions targeting the TyG index to enhance survival and quality of life in asthma patients.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"239 ","pages":"Article 107989"},"PeriodicalIF":3.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391641","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":"Home noninvasive ventilation in pediatric patients: Does one size fit all?","authors":"Sonia Khirani ,&nbsp;Lucie Griffon ,&nbsp;Alessandro Amaddeo ,&nbsp;Florent Baudin ,&nbsp;Priscille Bierme ,&nbsp;Jessica Taytard ,&nbsp;Nathalie Stremler ,&nbsp;Melisande Baravalle-Einaudi ,&nbsp;Julie Mazenq ,&nbsp;Iulia Ioan ,&nbsp;Cyril Schweitzer ,&nbsp;Marie-Emilie Lampin ,&nbsp;Alexandra Binoche ,&nbsp;Clémence Mordacq ,&nbsp;Jean Bergounioux ,&nbsp;Blaise Mbieleu ,&nbsp;Robert Rubinsztajn ,&nbsp;Elodie Sigur ,&nbsp;Géraldine Labouret ,&nbsp;Arnaud Bécourt ,&nbsp;Brigitte Fauroux","doi":"10.1016/j.rmed.2025.107983","DOIUrl":"10.1016/j.rmed.2025.107983","url":null,"abstract":"<div><h3>Background</h3><div>A French national survey showed that 1447 children were treated with long-term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in 2019. Data about the ventilatory settings for children are scarce. The aim of the study was to report the CPAP/NIV settings from the survey according to the patients’ age and disorders.</div></div><div><h3>Methods</h3><div>CPAP and NIV settings were compared between 5 age groups (&lt;1, 1–5, 6–11, 12–17 and ≥ 18 years), and 6 disease categories (upper airway disorders; neuromuscular disease, NMD; disorder of the central nervous system; cardiorespiratory disorder; congenital bone disease, CBD; and other).</div></div><div><h3>Results</h3><div>Age correlated positively with constant CPAP pressure (r = 0.364, p &lt; 0.0001), and negatively with CPAP adherence (r = −0.173, p &lt; 0.0001). Mean age at CPAP initiation, CPAP pressures and adherence did not differ between disorders. Regarding NIV, mean inspiratory positive airway pressure (IPAP) increased with age (r = 0.152, p = 0.0001), whereas respiratory rate (RR; r = −0.593, p &lt; 0.0001) and adherence to NIV decreased with age (r = −0.154, p = 0.0002). NIV settings were quite similar between disease categories, with the CBD group having the highest IPAP, and NMD group having the lowest expiratory positive airway pressure and RR. Adherence tended to be higher with NIV than CPAP.</div></div><div><h3>Conclusions</h3><div>CPAP pressure and IPAP increase with age, while settings seem quite similar between diseases. Even if our study provides some information about CPAP/NIV settings, they should always be individually adapted according to the severity of the disease.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107983"},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348825","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":"The impact of electronic cigarette use on chronic obstructive pulmonary disease: A systematic review and meta-analysis","authors":"Chunyan Song ,&nbsp;Xiaoning Hao ,&nbsp;Elena Critselis ,&nbsp;Demosthenes Panagiotakos","doi":"10.1016/j.rmed.2025.107985","DOIUrl":"10.1016/j.rmed.2025.107985","url":null,"abstract":"<div><h3>Objectives</h3><div>Electronic cigarette (or e-cigarette) use is increasing globally. To date, there are limited pooled estimates regarding the impact of e-cigarette use on <em>chronic obstructive pulmonary disease (COPD)</em>. The present meta-analysis of large-scale population-based observational studies evaluates the impact of e-cigarette use on COPD.</div></div><div><h3>Methods</h3><div>A systematic search of observational studies published between 1/2020-1/2024 was conducted in MEDLINE and Scopus based on PRISMA Guidelines.</div></div><div><h3>Results</h3><div>Of 3670 originally retrieved papers, 7 observational studies (including 4 cross-sectional studies and 3 prospective cohort studies) fulfilled all search criteria and were used for the present meta-analysis which encompassed in total, 3,552,424 participants, including 138,698 cases with COPD. The findings from the random-effects meta-analysis (I² = 22 %, Cochran Q (6) = 7.19, p = 0.307) suggested that use of e-cigarette among non-cigarette users was associated with (pooled Relative Risk, pRR) 1.50-times higher likelihood of COPD (95 % Confidence Interval (CI): 1.27, 1.73). Sensitivity analysis by leave-one-out analysis confirmed the aforementioned results (range of pRR values: 1.46 to 1.61, all p &lt; 0.001). Stratified pooled effect estimates of cross-sectional studies only (pOR = 1.55, 95 % CI: 1.26, 1.84) and of prospective cohort studies only (pRR = 1.52, 95 % CI: 0.98–2.06), revealed that the e-cigarette users exhibit between 52 % and 55 % significantly higher likelihood of COPD.</div></div><div><h3>Conclusions</h3><div>The current meta-analysis highlights that e-cigarette users face an increased risk of developing COPD. Therefore, public health interventions aimed at diminishing e-cigarette are necessary for preventing COPD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"239 ","pages":"Article 107985"},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374614","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":"Diagnostic and prognostic implications of a deep suprasternal notch in idiopathic pleuroparenchymal fibroelastosis","authors":"Yoshiaki Kinoshita,&nbsp;Chiharu Hirai,&nbsp;Keita Hara,&nbsp;Shota Takenaka,&nbsp;Takuhide Utsunomiya,&nbsp;Yuji Yoshida,&nbsp;Shota Nakashima,&nbsp;Hisako Kushima,&nbsp;Hiroshi Ishii","doi":"10.1016/j.rmed.2025.107986","DOIUrl":"10.1016/j.rmed.2025.107986","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a distinctive chronic interstitial lung disease characterized by upper lobe-dominant elastofibrosis. Deepening of the suprasternal notch is a notable physical feature in patients with iPPFE. However, the anatomical explanation and clinical significance of iPPFE have not yet been studied in detail.</div></div><div><h3>Methods</h3><div>We retrospectively examined 84 patients with iPPFE, 59 with idiopathic pulmonary fibrosis (IPF), 32 with chronic hypersensitivity pneumonitis (CHP), and 91 non-interstitial lung disease (ILD) controls. The depth of the suprasternal notch assessed on axial chest computed tomography and its association with clinical, radiological, and physiological parameters, and patient outcomes were investigated.</div></div><div><h3>Results</h3><div>The depth of the suprasternal notch was anatomically correlated with the thickness of the pre-tracheal soft tissue and posterior or right deviation of the trachea in patients with iPPFE. The depth of the suprasternal notch effectively discriminated patients with iPPFE from those with IPF (sensitivity, 75 %; specificity, 86.4 %), CHP (sensitivity, 75 %; specificity, 84.4 %), and non-ILD controls (sensitivity, 75 %; specificity, 83.5 %), with a cutoff value of 9.5 mm. A log-rank test showed that patients with iPPFE with a deep suprasternal notch had significantly shorter survival than those without a deep suprasternal notch. In addition, a multivariate Cox regression analysis adjusted for age, sex, and %forced vital capacity showed that the depth of the suprasternal notch was an independent risk factor for mortality.</div></div><div><h3>Conclusion</h3><div>The suprasternal notch is a simple and useful indicator with diagnostic and prognostic implications for patients with iPPFE.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107986"},"PeriodicalIF":3.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348826","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":"Local and systemic adverse effects of inhaled corticosteroids - Does ciclesonide differ from other inhaled corticosteroids?","authors":"Thera Gram Ottesen ,&nbsp;Alma Holm Rovsing ,&nbsp;Charlotte Suppli Ulrik","doi":"10.1016/j.rmed.2025.107962","DOIUrl":"10.1016/j.rmed.2025.107962","url":null,"abstract":"<div><h3>Background and aim</h3><div>The pharmacological profile of ciclesonide suggests that it may be associated with fewer local and systemic adverse effects compared to other inhaled corticosteroids. The aim of this systematic review is to provide an update on the current evidence of the local and systemic adverse effects of ciclesonide for the treatment of asthma compared to other inhaled corticosteroids.</div></div><div><h3>Methods</h3><div>Systematic review performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guidelines. The search was last updated in September 2024. The search algorithm consisted of the following Medical Subject Headings (MeSH) terms: (ciclesonide) AND (asthma).</div></div><div><h3>Results</h3><div>Of the 296 hits, 28 studies fulfilled the predefined criteria and were included in the present review. A total of 15 out of 25 studies addressing local adverse effects showed insignificant differences between ciclesonide and the comparative inhaled corticosteroid. Of these 15 studies, 13 were randomized controlled trials (RCTs). Seven RCTs reported a reduced risk of local adverse effects associated with ciclesonide-treatment. One observational study found ciclesonide treated patients more likely to have been treated for oropharyngeal candidiasis compared to patients treated with another inhaled corticosteroid.</div><div>Twelve studies investigated systemic adverse effects of CIC vs. other inhaled corticosteroid. Of the nine trials measuring urine cortisol suppression compared to baseline, seven found no suppression in the ciclesonide treated groups in contrast to a significant suppression in the comparative inhaled corticosteroid treated groups. On the contrary, two trials found no suppression in either treatment group. Two of three studies assessing HPA-axis function by plasma cortisol response to corticotropin-releasing factor reported no difference between ciclesonide and fluticasone propionate, whereas one found significantly reduced response with fluticasone treatment, but not with ciclesonide. One study assessed the risk of developing signs of cataract and found no significant difference between ciclesonide and other inhaled corticosteroids, and another investigated patient reported adverse effects and found superiority in CIC to FP in terms of reducing “vision deterioration”.</div></div><div><h3>Conclusion</h3><div>The current evidence of possible differences in adverse effects between ciclesonide and other inhaled corticosteroids are conflicting. However, there is some evidence in favor of fewer local adverse effects in ciclesonide treated patients and, additionally, ciclesonide treatment is either more favorable or similar to other inhaled corticosteroids with regard to systemic adverse effects.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107962"},"PeriodicalIF":3.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372056","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}