Respirology最新文献

{"title":"Taking an Effective Occupational History: Challenges and Opportunities in Respiratory Health.","authors":"Ryan F Hoy, Adrienne Edwards","doi":"10.1111/resp.70070","DOIUrl":"https://doi.org/10.1111/resp.70070","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Pneumothorax After Treatment With Endobronchial Valves: A Cohort Study.","authors":"Kirstine Hermann Jørgensen, Thomas Decker Christensen, Ingrid Louise Titlestad, Jesper Rømhild Davidsen, Kathrine Bock, Kristine Jensen, Morten Bendixen, Ole Dan Jørgensen, Michael Perch, Elisabeth Bendstrup","doi":"10.1111/resp.70069","DOIUrl":"https://doi.org/10.1111/resp.70069","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pneumothorax (PTX) is the most prevalent and serious adverse event associated with endobronchial valve (EBV) treatment in chronic obstructive pulmonary disease (COPD) with emphysema. This study aimed to compare preoperative characteristics and 30-day outcomes in patients with COPD with and without PTX.</p><p><strong>Method: </strong>This retrospective nationwide cohort study included patients treated with EBV between 2017 and 2023 at all EBV centres in Denmark. Data were retrieved from medical records.</p><p><strong>Results: </strong>A total of 228 patients were included, of whom 46 (20.2%) had PTX. The median time to PTX was 7 h (IQR 2-22) and the median drain treatment duration was 13 days (IQR 8.5-22). The risk of PTX was significantly higher when EBV treatment was performed in the upper lobes than in the lower lobes (adjusted RR 6.32, 95% CI 2.56-15.60). High target lobe volume (adjusted OR pr 100 mL increase 1.12, 95% CI 1.02-1.22) and high residual volume (adjusted OR pr 10%pt. increase 1.11, 95% CI 1.01-1.23) were independent risk factors for PTX. More PTX patients had atelectasis after 2 h compared to patients without PTX. The risk of pneumonia (RR 4.5, 95% CI 1.7-11.8), empyema (p = 0.0047) and ICU admission (RR 9.89, 95% CI 1.98-49.4) were significantly higher in the PTX patients than in the patients without PTX.</p><p><strong>Conclusions: </strong>PTX was more prevalent when EBV treatment was performed in the upper lobes and with high residual volume and target lobe volume, leading to prolonged hospital admission and risk of hospital-acquired pneumonia.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The TSANZ Practical Guide for Clinicians in the Management of Screen- and Incidentally-Detected Nodules.","authors":"Fraser Brims, Annette McWilliams, Jonathan Williamson, Miranda Siemienowicz, Tracy L Leong","doi":"10.1111/resp.70065","DOIUrl":"https://doi.org/10.1111/resp.70065","url":null,"abstract":"<p><p>The increasing adoption of lung cancer screening programs and advancements in imaging technologies has significantly increased the detection of pulmonary nodules, both incidentally and through screening. This document provides a comprehensive guide for clinicians to address the complexities of managing indeterminate pulmonary nodules (IPNs), emphasising person-centred and multidisciplinary care. IPNs are categorised based on size and morphology, with specific guidelines for malignancy risk stratification, diagnostic evaluation, and follow-up. Dedicated lung nodule evaluation teams (LNETs) and nodule multidisciplinary meetings (MDMs) play a critical role in ensuring guideline adherence, streamlining the diagnostic pathway, reducing unnecessary investigations, and improving outcomes. Structured IPN programs have demonstrated benefits in early lung cancer detection, improved detection of early-stage lung cancer, and reduced delays to treatment initiation. Effective management strategies include use of standardised reporting templates, utilising validated risk models such as the PanCan malignancy risk model and agreed protocols for follow up of IPNs. This document highlights the importance of accessing prior imaging to assess for growth and accounting for technical differences between computed tomography (CT) scans. Any nodule considered to be growing requires discussion at a nodule MDM with decision to act for tissue biopsy as appropriate. A nodule MDM will assist in optimising the safest and most efficient biopsy techniques based on nodule characteristics and risk profile. By integrating multidisciplinary expertise and adhering to evidence-based protocols, services can improve the timely diagnosis and management of IPNs, minimise over-investigation, reduce chance of overdiagnosis and ultimately enhance patient outcomes and lung cancer survival.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Concise Review 2024: Chronic Obstructive Pulmonary Disease.","authors":"Sarita Thawanaphong, Parameswaran Nair","doi":"10.1111/resp.70062","DOIUrl":"https://doi.org/10.1111/resp.70062","url":null,"abstract":"<p><p>Non-smoking COPD is common in LMICs, especially in women. Biomass fuel and air pollution are major risk factors with distinct pathophysiology. The 'eosinophilic' endotype in COPD is biologically distinct from asthma. PRISm, FEV₁/FVC Z-scores, and quantitative CT improve early COPD detection. Dupilumab (anti-IL-4/IL-13) improved exacerbations and lung function in COPD with blood eosinophils ≥ 300 cells/μL. Mechanisms are currently being investigated. Smoking cessation remains pivotal. Nicotine metabolite ratio (NMR) can guide pharmacotherapy. Cytisine and varenicline are effective; e-cigarettes pose safety concerns. Mood disorders and dysfunctional breathing are common in COPD. Addressing these can reduce symptom burden and improve quality of life. Comorbidity management, particularly of cardiovascular risk, obesity, and sleep-disordered breathing, is integral to holistic COPD care.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Society of Australia and New Zealand (TSANZ) Guidance for the Management of Electronic Cigarette Use (Vaping) in Adolescents and Adults.","authors":"Henry Marshall, Moya Vandeleur, Emma Dean, Chris Barton, Nia Luxton, Kristin Carson-Chahhoud, Andre Schultz, Janet Williams, Tahlia Grammatopoulos, Emily Stone, Smita Shah, Stuart Jones, Christine F McDonald, Matthew Peters","doi":"10.1111/resp.70066","DOIUrl":"https://doi.org/10.1111/resp.70066","url":null,"abstract":"<p><p>Electronic cigarette (EC) use, especially among younger members of society, has grown to concerning levels in many countries, including Australia and New Zealand. Uptake in the general population, driven by technological and pharmacological innovations, and accelerated by aggressive tobacco/vaping industry marketing, has outpaced medical research. As the harms of EC use become increasingly evident, the Australian Government has introduced policies to curb recreational EC use, whilst still allowing access for smoking cessation. This highly dynamic environment presents new challenges to clinicians as the evidence to support clinical practice with respect to vaping use and its cessation remains very limited. This guidance document from the Thoracic Society of Australia and New Zealand aims to address this unmet need by offering practical advice for clinicians to help protect their patients' lung and general health by: preventing EC uptake in children, adolescents, and young adults; providing guidance for ceasing EC use in adolescents and adults who have never smoked; and providing guidance for ceasing EC use in people who currently or formerly smoked who now use EC long-term. Underpinned by a systematic review, this multidisciplinary expert consensus document summarises the current landscape of EC use, nicotine addiction, behavioural and pharmacotherapy treatments. Illustrative case vignettes are provided. The advice, largely extrapolated from the smoking cessation literature, is based on the consensus of the authors in the absence of high-quality randomised trials for vaping cessation and is applicable to all age groups. We emphasise the urgent unmet need for vaping-specific cessation research to inform future practice.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human and Deep Learning Predictions of Peripheral Lung Cancer Using a 1.3 mm Video Endoscopic Probe.","authors":"Edoardo Amante, Robin Ghyselinck, Luc Thiberville, Rocco Trisolini, Florian Guisier, Valentin Delchevalerie, Bruno Dumas, Benoît Frénay, Inès Duparc, Nicolas Mazellier, Cecile Farhi, Christophe Jubert, Mathieu Salaün, Samy Lachkar","doi":"10.1111/resp.70057","DOIUrl":"https://doi.org/10.1111/resp.70057","url":null,"abstract":"<p><strong>Background and objective: </strong>Iriscope, a 1.3 mm video endoscopic probe introduced through an r-EBUS catheter, allows for the direct visualisation of small peripheral pulmonary nodules (PPNs). This study assessed the ability of physicians with different levels of experience in bronchoscopy, and the ability of artificial intelligence (AI) to predict the malignant nature of small PPNs during Iriscope peripheral endoscopy.</p><p><strong>Methods: </strong>Patients undergoing bronchoscopy with r-EBUS and Iriscope for peripheral PPNs < 20 mm with a definite diagnosis were analysed. Senior and Junior physicians independently interpreted video-recorded Iriscope sequences, classifying them as tumoral (malignant) or non-tumoral, blind to the final diagnosis. A deep learning (DL) model was also trained on Iriscope images and tested on a different set of patients for comparison with human interpretation. Diagnostic accuracy, sensitivity, specificity, and F1 score were calculated.</p><p><strong>Results: </strong>Sixty-one patients with small PPNs (median size 15 mm, IQR: 11-20 mm) were included. The technique allowed for the direct visualisation of the lesions in all cases. The final diagnosis was cancer for 37 cases and a benign lesion in 24 cases. Senior physicians outperformed junior physicians in recognising tumoral Iriscope images, with a balanced accuracy of 85.4% versus 66.7%, respectively, when compared with the final diagnosis. The DL model outperformed junior physicians with a balanced accuracy of 71.5% but was not superior to senior physicians.</p><p><strong>Conclusion: </strong>Iriscope could be a valuable tool in PPNs management, especially for experienced operators. Applied to Iriscope images, DL could enhance overall performance of less experienced physicians in diagnosing malignancy.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inspiratory Muscle Training on Exercise Capacity, Dyspnoea and Health Status in Pulmonary Hypertension: A Randomised Controlled Trial.","authors":"Fabrício Farias da Fontoura, Gabriela Roncato, Gisela Martina Bohns Meyer, Cássia da Luz Goulart, Fernanda Brum Spilimbergo, Gerson Cipriano Junior, Marilia Gabriela Bernadeli, Katya Rigatto, Danilo Cortozi Berton","doi":"10.1111/resp.70054","DOIUrl":"https://doi.org/10.1111/resp.70054","url":null,"abstract":"<p><strong>Background and objective: </strong>To evaluate the effects of a high-intensity inspiratory muscle training on respiratory muscle strength, exercise capacity, dyspnoea, and health-related quality of life (HRQL) in patients with pulmonary hypertension (PH).</p><p><strong>Methods: </strong>Single-blinded, randomised controlled trial 35 women with clinically stable PH (subgroups 1 and 4), functional class II and III, were randomly assigned to a high-intensity inspiratory muscle training (IMT) or sham training. Daily 8-week IMT protocol with 50% (IMT-50%) of maximal inspiratory muscle pressure (PImax) or sham training with a fixed load of 3 cmH₂O (IMT-S). Daily training time consisted of 2 cycles of 30 dynamic inspiratory efforts twice daily, 7 days/week, for 8 weeks using an inspiratory threshold-loading device.</p><p><strong>Results: </strong>There were significantly greater improvements in the intervention group (17 patients) compared to sham (14 patients) on PImax [Δpost-pre = 56.4 cmH₂O (95% CI 63.5 to 49.3) versus IMT-S 25.2 cmH₂O (95% CI 33.1 to 17.4), p < 0.001]. The intervention group improved their 6MWT [Δpost-pre, IMT 50% = 33.5 m (95% CI 15.9 to 51.2) vs. IMT-S -1.1 m (95% CI -26.7 to 24.4), p < 0.001]. Dyspnoea perception at the end of the 6-min walk test (6MWT) and mMRC significantly improved in the IMT-50% group: Dyspnoea [Δpost-pre = -1.1 (95% CI -1.5 to -0.7) vs. IMT-S -0.2 (95% CI -1.3 to 0.9), p < 0.001] and mMRC [Δpost-pre = -0.6 (95% CI -0.8 to 0.3) vs. IMT-S 0 (95% CI -0.2 to 0.2), p < 0.001].</p><p><strong>Conclusions: </strong>A high-intensity protocol of IMT improves respiratory muscle strength, exercise capacity, and dyspnoea in symptomatic patients with PH.</p><p><strong>Trial registration: </strong>The trial was recorded on the Trials registry RBR-33gm3k (https://ensaiosclinicos.gov.br/rg/RBR-33gm3k).</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking Asthma Remission: Key Insights From an Expert Roundtable Discussion.","authors":"Dennis Thomas, Hayley Lewthwaite, Peter G Gibson, Eleanor Majellano, Vanessa Clark, Michael Fricker, Yuto Hamada, Gary P Anderson, Vibeke Backer, Philip Bardin, Richard Beasley, Jimmy Chien, Claude S Farah, John Harrington, Erin Harvey, Mark Hew, Anne E Holland, Christine Jenkins, Constance H Katelaris, Gregory Katsoulotos, Kirsty Murray, Matthew Peters, Rejoy Thomas, Katrina Tonga, John W Upham, Peter Wark, Vanessa M McDonald","doi":"10.1111/resp.70047","DOIUrl":"https://doi.org/10.1111/resp.70047","url":null,"abstract":"<p><p>Treatment targets in severe asthma have evolved towards a remission-focused paradigm guided by precision medicine. This novel concept requires a shift from evaluating the efficacy of therapies based on a single outcome at a single time point to an outcome that captures the complexity of asthma remission involving several domains assessed over a sustained period. Since the concept is still emerging, multiple definitions have been proposed, ranging from symptom control and exacerbation-free to resolution of underlying pathobiology, with varying rigour in each parameter. Understanding the strengths and weaknesses of the current construct is needed to progress further. We conducted a roundtable discussion with 27 asthma experts to address this issue, and discussions were narratively synthesised and summarised. The participants observed that between one in three and one in five people treated with targeted biological therapies or macrolides experience low disease activity over a sustained period. They unanimously agreed that labelling the attained clinical state as clinical remission is useful as a clinical (e.g., facilitating a treat-to-target approach), policy (e.g., widening eligibility criteria for biologics), and scientific (e.g., a path to understanding cure) tool. Current remission rates vary significantly due to definition variability. When assessing remission, it is essential to consider confounding factors (e.g., steroid use for adrenal insufficiency). More research is required to reach an acceptable definition, and including the patient's voice in such research is essential. In conclusion, the concept of treatment-induced clinical remission is possible and valuable in asthma. However, further refinement of the definition is required.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Fixed CPAP at 10 cmH₂O for OSA: A One-Size-Fits-All Approach?\"","authors":"Yuanming Luo, Lu Wang, Danny J Eckert","doi":"10.1111/resp.70061","DOIUrl":"https://doi.org/10.1111/resp.70061","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixed CPAP at 10 cmH₂O for OSA: A One-Size-Fits-All Approach?","authors":"Ahmed Mueed, Maira Ilyas","doi":"10.1111/resp.70060","DOIUrl":"https://doi.org/10.1111/resp.70060","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}