Respirology最新文献

{"title":"Impact of Pulmonary Artery Pressure on the Response to Oxygen Administration for Exertional Desaturation in Interstitial Lung Disease.","authors":"Jun Hirasawa, Ryo Teramachi, Jun Fukihara, Fumiko Watanabe, Tomoya Ogawa, Reoto Takei, Yasuhiko Yamano, Kensuke Kataoka, Kazuaki Soejima, Tomoki Kimura, Yasuhiro Kondoh","doi":"10.1111/resp.70032","DOIUrl":"10.1111/resp.70032","url":null,"abstract":"<p><strong>Background and objective: </strong>Patients with interstitial lung disease (ILD) often experience exertional desaturation even without resting hypoxemia, resulting in limited exercise capacity. While oxygen administration can extend exercise time in a majority of patients with ILD, the factors determining the oxygen effects are unclear. We aimed to investigate the clinical significance of respiratory and pulmonary haemodynamic parameters for the oxygen effects on exercise time in patients with ILD.</p><p><strong>Methods: </strong>We retrospectively analysed patients with ILD who underwent comprehensive evaluation including right heart catheterisation from 2017 to 2021. Patients were divided into oxygen responders, defined as an improvement of at least 100 s or 33% in exercise time with oxygen supplementation compared with medical air inhalation, and non-responders. Univariate and multivariate logistic regression analyses were conducted to evaluate significant factors for oxygen responders.</p><p><strong>Results: </strong>Among 86 patients, 50 (58.1%) were oxygen responders. Pulmonary functional tests and ventilation parameters at cardiopulmonary exercise testing were similar between the groups. Mean pulmonary arterial pressure (mPAP) (21 mmHg vs. 19 mmHg, p = 0.049) was higher in oxygen responders. Univariate logistic analysis demonstrated that the ILD-Gender-Age-Physiology index, mPAP, 6-min walking distance, peak work rate, and lowest ventilatory equivalent for carbon dioxide were significant variables for oxygen effects on exercise time. Multivariate analysis demonstrated that elevated mPAP was independently associated with the oxygen effects on exercise time.</p><p><strong>Conclusion: </strong>Approximately 60% of the patients with ILD who experienced exertional desaturation without resting hypoxemia were oxygen responders. mPAP was associated with the oxygen effects on exercise time.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"662-670"},"PeriodicalIF":6.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111865","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":"Recommendations From the Medical Education Editor.","authors":"Mark Lavercombe","doi":"10.1111/resp.70074","DOIUrl":"10.1111/resp.70074","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"544-546"},"PeriodicalIF":6.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267146","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":"10.1111/resp.70060","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"680-681"},"PeriodicalIF":6.6,"publicationDate":"2025-07-01","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}

{"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":"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":"558-573"},"PeriodicalIF":6.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231763/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sliding Into Misdiagnosis? Distinguishing Bullous Emphysema From Pneumothorax With Lung Ultrasound.","authors":"Casper Falster","doi":"10.1111/resp.70038","DOIUrl":"10.1111/resp.70038","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"550-551"},"PeriodicalIF":6.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701386","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 Risk-Benefit Balance of Oral Corticosteroid Treatment for Asthma Attacks: A Discrete Choice Experiment of Patients and Healthcare Professionals in the UK and New Zealand.","authors":"Imran Howell, Jonathan Noble, Aleksandra Howell, Caitlin Morgan, Jennifer Logan, Sarah Miller, Rekha Chaudhuri, Richard E K Russell, Mona Bafadhel, Richard Beasley, Ian D Pavord, John Buckell","doi":"10.1111/resp.70077","DOIUrl":"https://doi.org/10.1111/resp.70077","url":null,"abstract":"<p><strong>Background and objective: </strong>Oral corticosteroids (OCS) are the guideline recommended treatment for all asthma attacks, but benefits must be considered alongside the potential for cumulative side-effects. There is interest in trialling biomarker-directed management of attacks to rationalise OCS treatment in those with least benefit. Understanding stakeholder perspectives on the risks and benefits associated with OCS treatment can inform trial design and shared decision-making discussions in clinical practice. The aim was to examine patients' and healthcare professionals' preferences for the risks and benefits associated with OCS treatment for asthma attacks.</p><p><strong>Methods: </strong>Discrete choice experiment (DCE) by patients with asthma and HCPs in the UK and New Zealand. Preferences were analysed using logit models.</p><p><strong>Results: </strong>Eight hundred and twenty-four patients and 171 HCPs completed the DCE. Avoiding the risks of permanent side effects had the greatest impact on treatment preference by patients and HCPs. Avoidance of side effects was weighted higher by patients than HCPs. Patients with uncontrolled asthma were more prepared to trade risk for benefit. Symptom recovery was the most valued clinical benefit to patients and HCPs. Patients preferred 'improving lung function' over 'avoiding additional GP treatment or hospitalisation', whereas HCPs preferred avoidance of further healthcare utilisation. Based on their responses we estimated the minimum clinically important difference for the treatment failure outcome at 20%.</p><p><strong>Conclusion: </strong>Patients and HCPs will trade-off treatment benefits to avoid the side-effects associated with OCS. The risk-benefit balance of OCS should feature in shared decision-making discussions with patients experiencing outpatient asthma attacks. The findings support developing trials to personalise acute asthma treatment.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529463","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 Model for Predicting Survival Outcomes Using Functional Exercise and Patient-Reported Outcomes in Fibrotic Interstitial Lung Disease: A Prospective Observational Study.","authors":"Lan-Yan Yang, Hsin-Ting Yang, Yi-Hsuan Yu, Pin-Kuei Fu","doi":"10.1111/resp.70076","DOIUrl":"https://doi.org/10.1111/resp.70076","url":null,"abstract":"<p><strong>Background and objective: </strong>Fibrotic interstitial lung disease (F-ILD) has high mortality, necessitating multidimensional staging to assess severity, predict prognosis, and guide treatment. However, the gender-age-physiology (GAP) index lacks patient-reported outcome measures (PROMs) and exercise test parameters, and traditional methods may miss complex variable interactions. The study aimed to develop a risk model of mortality in F-ILD using routine PROMs and exercise test parameters, and to compare the predictive performance with GAP staging system.</p><p><strong>Methods: </strong>Between December 2018 and December 2022, 246 patients from the ILD Prospective Registry with at least 1 year of follow-up (excluding death) were enrolled. Baseline assessments included GAP, 1MSTS, 6MWD, mMRC, SGRQ, and SF36. A tree-based risk model was developed and validated with a 2:1 split. Kaplan-Meier curves and Cox regression were used to estimate survival and hazard ratios, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>The very-high-risk group (SGRQ > 34.5, 1MSTS < 21) had a significantly higher hazard ratio (HR = 5.13; 95% CI: 2.54-10.35) compared to the non-very-high-risk group. Their 1-, 2-, and 5-year mortality rates were 28.87%, 47.18%, and 82.42%, respectively, similar to GAP stage III but with narrower confidence intervals.</p><p><strong>Conclusion: </strong>This study developed a prognostic model for F-ILD combining PROMs and functional exercise data. The model, which includes the SGRQ, 6MWD, and 1MSTS, outperforms GAP staging, offering benefits like reduced patient fatigue and improved monitoring. Multicenter studies are needed to validate these findings.</p><p><strong>Trial registration: </strong>The study was registered on ClinicalTrials.gov (NCT06476470).</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529461","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 Assessment of Subglottic and Cervical Tracheal Stenosis Using a Novel Point-of-Care Ultrasound Method: Measurement of Tracheal Radius Curvature.","authors":"Jieru Lin, Zhina Wang, Mingming Deng, Lin Su, Hong Chen, Hanliang Jiang, Yang Xia, Xianwei Ye, Nan Zhang, Hongmei Yao, Min Liu, Jiaojiao Ma, Jie Wu, Xuelian Li, Shuai Zhao, Liwei Liao, Gang Hou","doi":"10.1111/resp.70081","DOIUrl":"https://doi.org/10.1111/resp.70081","url":null,"abstract":"<p><strong>Background and objective: </strong>The air way dimensions are important in the assessment, treatment and follow-up of patients with tracheal and subglottic stenosis (SGS). Non-invasive, non-radioactive methods to assess the degree of stenosis are needed. Point-of-care ultrasonography (POCUS) is an effective method for assessing the subglottic diameter and evaluating the abnormal airway. We explore the accuracy of POCUS measurement of the diameter of the subglottic and cervical trachea in patients with SGS and tracheal stenosis.</p><p><strong>Methods: </strong>In this prospective, multi-centre study, volunteers and patients with SGS underwent POCUS, CT scanning, and flexible bronchoscopy. A radiologist measured the anteroposterior and transverse diameters of the trachea on the CT images and calculated the mean diameter (CT-mean). Air column width (ACW) and anterior tracheal wall thickness (ATWT) were obtained by POCUS. The diameter of the subglottic and cervical trachea was calculated using an equation based on the radius of curvature (CR).</p><p><strong>Results: </strong>A total of 123 volunteers without tracheal disease and 103 patients with SGS participated in this study. We identified strong correlation between airway diameter measurement using US-CR and CT-mean (r = 0.96 and 0.95, p < 0.001, respectively) in both, the control group and in patients with SGS. The diameter of subglottic and cervical trachea assessed by US-CR is more accurate than the direct measurement of US-ACW. The intraobserver and interobserver repeatability of US-CR was excellent (all correlation coefficients > 0.95; p < 0.05).</p><p><strong>Conclusion: </strong>The airway dimension measured using POCUS based on the radius of the curvature is a reliable tool for assessing the subglottic and cervical tracheal diameters.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529462","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 Case for Case Finding Is Getting Stronger.","authors":"Christine Jenkins","doi":"10.1111/resp.70022","DOIUrl":"10.1111/resp.70022","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"459-460"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639653","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":"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":"466-479"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128732/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}