Respirology最新文献

{"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}

{"title":"Prediction of Lymph Node Metastasis in Lung Cancer Using Deep Learning of Endobronchial Ultrasound Images With Size on CT and PET-CT Findings.","authors":"Ji Eun Oh, Hyun Sung Chung, Hye Ran Gwon, Eun Young Park, Hyae Young Kim, Geon Kook Lee, Tae-Sung Kim, Bin Hwangbo","doi":"10.1111/resp.70010","DOIUrl":"10.1111/resp.70010","url":null,"abstract":"<p><strong>Background and objective: </strong>Echo features of lymph nodes (LNs) influence target selection during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). This study evaluates deep learning's diagnostic capabilities on EBUS images for detecting mediastinal LN metastasis in lung cancer, emphasising the added value of integrating a region of interest (ROI), LN size on CT, and PET-CT findings.</p><p><strong>Methods: </strong>We analysed 2901 EBUS images from 2055 mediastinal LN stations in 1454 lung cancer patients. ResNet18-based deep learning models were developed to classify images of true positive malignant and true negative benign LNs diagnosed by EBUS-TBNA using different inputs: original images, ROI images, and CT size and PET-CT data. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC) and other diagnostic metrics.</p><p><strong>Results: </strong>The model using only original EBUS images showed the lowest AUROC (0.870) and accuracy (80.7%) in classifying LN images. Adding ROI information slightly increased the AUROC (0.896) without a significant difference (p = 0.110). Further adding CT size resulted in a minimal change in AUROC (0.897), while adding PET-CT (original + ROI + PET-CT) showed a significant improvement (0.912, p = 0.008 vs. original; p = 0.002 vs. original + ROI + CT size). The model combining original and ROI EBUS images with CT size and PET-CT findings achieved the highest AUROC (0.914, p = 0.005 vs. original; p = 0.018 vs. original + ROI + PET-CT) and accuracy (82.3%).</p><p><strong>Conclusion: </strong>Integrating an ROI, LN size on CT, and PET-CT findings into the deep learning analysis of EBUS images significantly enhances the diagnostic capability of models for detecting mediastinal LN metastasis in lung cancer, with the integration of PET-CT data having a substantial impact.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"515-522"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543329","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":"Impact of A Multidisciplinary Team Discussion for Genetic Lung Fibrosis.","authors":"Giovanni Franco, Ibrahima Ba, Nadia Nathan, Cécile Guerin, Albane Lassus, Caroline Kannengiesser, Antoine Froidure, Effrosyni Manali, Vincent Bunel, Philippe Bonniaud, Diane Bouvry, Marie Pierre Debray, Pierre Antoine Juge, Ralph Epaud, Camille Louvrier, Aurélie Plessier, Flore Sicre de Fontbrune, Lidwine Wémeau-Stervinou, Sylvain Marchand Adam, Alexandre Chabrol, Arnaud Maurac, Laurent Savale, David Montani, Caroline Raynal, Marina Konyukh, Arthur Mageau, Bruno Crestani, Vincent Cottin, Alix de Becdelièvre, Raphaël Borie","doi":"10.1111/resp.70039","DOIUrl":"10.1111/resp.70039","url":null,"abstract":"<p><strong>Background and objective: </strong>Approximately 30% of individuals diagnosed with familial pulmonary fibrosis (FPF) exhibit a pathogenic variant upon genetic analysis. We established a genetic Multidisciplinary Discussion (geneMDD) aimed to enhance expertise in diagnosing and managing FPF. This study aimed at prospectively evaluating the impact of geneMDD on diagnosis and treatment in patients referred to geneMDD.</p><p><strong>Methods: </strong>In this prospective study, we enrolled all consecutive patients referred to the geneMDD. At each meeting, the impact of the meeting was questioned on the genetic conclusion, the pulmonary diagnosis, and the treatment.</p><p><strong>Results: </strong>A total of 115 patients were included. Before geneMDD, rare variants were detected in 82 out of 107 patients, among which 65 variants were classified as pathogenic/likely pathogenic. Following geneMDD, 2 pathogenic variants (3%) were reclassified as variants of uncertain significance (VUS) (n = 1) or benign (n = 1). Among the 17 variants initially classified as VUS, 2 (11.8%) were reclassified as likely pathogenic/pathogenic. The pulmonary diagnosis was confirmed for all patients (unclassifiable lung fibrosis was the more frequent diagnosis, n = 38, 33.0%). The therapeutic regimen was changed after geneMDD in 30 patients. Factors associated with therapeutic changes included the pulmonary diagnosis and presence of a pathogenic/likely pathogenic variant. In addition, the French health system allows offering whole genome sequencing (WGS) in patients with a first negative genetic analysis by NGS panel after discussion in geneMDD, but in total, since September 1st, 2021, WGS was negative for the four analysed families.</p><p><strong>Conclusion: </strong>This study suggests that geneMDD could influence the treatment of FPF patients.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"523-532"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711169","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":"A Two-Staged, Risk-Stratified Strategy Combining FEV₁/FEV₆ and COPD Diagnostic Questionnaire Acts as an Accurate and Cost-Effective COPD Case-Finding Method.","authors":"Po-Chun Lo, Hsin-Kuo Ko, Kun-Ta Chou, Yi-Han Hsiao, Diahn-Warng Perng, Kang-Cheng Su","doi":"10.1111/resp.70000","DOIUrl":"10.1111/resp.70000","url":null,"abstract":"<p><strong>Background and objective: </strong>Symptom-based questionnaires and handheld lung function devices are widely used for COPD case finding, but the optimal combination remains unclear. This study aimed to compare the diagnostic accuracy (DA) of various combinations of handheld lung function devices and questionnaires and develop a COPD case-finding strategy.</p><p><strong>Methods: </strong>This cross-sectional, prospective, observational study enrolled participants aged ≥ 40 years with respiratory symptoms and ≥ 10 smoking pack-years. Participants completed three questionnaires (COPD diagnostic questionnaire [CDQ], lung function questionnaire; COPD Population Screener) and 2 handheld lung function devices (peak flow meter, microspirometer), followed by spirometry to confirm COPD (post-bronchodilation FEV₁/FVC < 0.7). DA is assessed using the area under the ROC curve (AUROC).</p><p><strong>Results: </strong>Among 224 participants, COPD incidence was 29%. Individually, handheld devices showed significantly higher DA than questionnaires (AUROC 0.678-0.69 for questionnaires vs. 0.807 for peak expiratory flow rate [PEFR] and 0.888 for FEV₁/FEV₆; all pairwise p < 0.05). FEV₁/FEV₆-based combinations outperformed PEFR-based combinations (all n = 224; AUROC 0.897-0.903 vs. 0.810-0.818; p < 0.05). The CDQ and FEV₁/FEV₆ combination reached the highest DA (AUROC 0.903). FEV₁/FEV₆ < 0.76 was the optimal cutoff value. A two-staged strategy (sensitivity/specificity 0.82/0.84) was proposed: low-risk participants (CDQ ≤ 13) need no further testing; middle-risk (CDQ 14-26) should undergo FEV₁/FEV₆; and high-risk (CDQ ≥ 27) and middle-risk with FEV₁/FEV₆ < 0.76 require confirmatory spirometry. This approach would reduce misdiagnoses and save costs and time compared to FEV₁/FEV₆ alone.</p><p><strong>Conclusion: </strong>FEV₁/FEV₆ and CDQ combination achieves the highest DA. A two-staged, risk-stratified strategy combining CDQ and FEV₁/FEV₆ can be accurate and cost-effective to detect at-risk, undiagnosed COPD subjects. External validation is required.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"493-503"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399883","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":"Treatable Trait Guided Asthma Management: A Feasibility Study.","authors":"James Fingleton, Rob McLachlan, Jenny Sparks, Richard Beasley, Alvar Agustí, Peter G Gibson, Ian D Pavord, Jo Hardy, Mark Weatherall, Allie Eathorne, Vanessa M McDonald","doi":"10.1111/resp.70016","DOIUrl":"10.1111/resp.70016","url":null,"abstract":"<p><strong>Background and objectives: </strong>Treatable trait-based personalised medicine improves outcomes in severe asthma clinics. We assessed the feasibility of a randomised controlled trial (RCT) of protocolised treatable trait-guided asthma management in patients not under a severe asthma clinic.</p><p><strong>Methods: </strong>Ten week single-group cohort study. Participants had a doctor's diagnosis of asthma, Asthma Control Questionnaire-5 (ACQ-5) score > 1, and ≥ 1 exacerbation in the last year.</p><p><strong>Intervention: </strong>biomarker-guided asthma medication according to a protocolised algorithm, targeting traits of type-2 inflammation and airflow obstruction. Feasibility outcomes: recruitment rates, acceptability of intervention, willingness to enrol in an RCT, need for 'extended' trait assessment after 10 weeks, and estimation of trait prevalence.</p><p><strong>Results: </strong>Recruitment ceased with 29/50 participants after 14 months due to difficulties associated with COVID-19. Recruitment rate: 29/118 (25%) of those invited to participate (95% CI 17 to 33). 24/26 (92%) participants found the intervention acceptable and were willing to participate in a future study. After 10 weeks, 65% remained not well controlled (ACQ-5 > 1) and would have required the 'extended' assessment. Participants had a mean (SD) 4.8 (2.3) of 13 traits assessed. ACQ-5 improved during the study by -1.0 (0.3 to 1.8) units, and post-bronchodilator airflow limitation reduced from 59% of participants to 35%. 12/29 (41%) participants received continuous oral corticosteroids at some point during the study.</p><p><strong>Conclusion: </strong>Protocolised treatable trait management was acceptable to participants, associated with significant clinical benefit, and a full RCT appears feasible. Targeting type-2 inflammation and airflow obstruction was insufficient to control asthma in the majority of patients, despite marked systemic corticosteroid exposure.</p><p><strong>Trial registration: </strong>ACTRN12620000935932.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"480-492"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617045","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":"A Global Achievement: Introducing the Inducible Laryngeal Dysfunction/Vocal Cord Dysfunction Toolkit-A Free Global, Peer-Reviewed Clinical Resource.","authors":"Paul Leong, Vanessa L Clark, Peter G Gibson, Vanessa M McDonald, Philip G Bardin","doi":"10.1111/resp.70055","DOIUrl":"10.1111/resp.70055","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"537-538"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031005","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":"COPD and Lung Cancer: Shared Risks and Connections.","authors":"Fanny Wai San Ko","doi":"10.1111/resp.70044","DOIUrl":"10.1111/resp.70044","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"533-534"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034626","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":"Pre-Treatment MMP7 Predicts Progressive Idiopathic Pulmonary Fibrosis in Antifibrotic Treated Patients.","authors":"Roger M Li, Dino B A Tan, Chantalia Tedja, Wendy A Cooper, Helen E Jo, Christopher Grainge, Ian N Glaspole, Nicole Goh, Samantha Ellis, Peter M A Hopkins, Christopher Zappala, Gregory J Keir, Paul N Reynolds, Sally Chapman, E Haydn Walters, Darryl Knight, Svetlana Baltic, HuiJun Chih, Tamera J Corte, Yuben P Moodley","doi":"10.1111/resp.14894","DOIUrl":"10.1111/resp.14894","url":null,"abstract":"<p><strong>Background and objective: </strong>Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with a poor prognosis. Antifibrotics slow the decline of pulmonary function after 12-months, but limited studies have examined the role of circulatory biomarkers in antifibrotic treated IPF patients.</p><p><strong>Methods: </strong>Serum from 98 IPF participants, from the Australian Idiopathic Pulmonary Fibrosis Registry were collected at four time-points over 1 year post-antifibrotic treatment and analysed as two separate cohorts. Patients were stratified as progressive, if they experienced ≥ 10% decline in FVC or ≥ 15% decline in DLCO or were deceased within 1 year of treatment initiation: or otherwise as stable. Ten molecules of interest were measured by ELISAs in patient serum.</p><p><strong>Results: </strong>Baseline MMP7 levels were higher in progressive than stable patients in Cohort 1 (p = 0.02) and Cohort 2 (p = 0.0002). Baseline MMP7 levels also best differentiated progressive from stable patients (Cohort 1, AUC = 0.74, p = 0.02; Cohort 2, AUC = 0.81, p = 0.0003). Regression analysis of the combined cohort showed that elevated MMP7 levels predicted 12-month progression (OR = 1.530, p = 0.010) and increased risk of overall mortality (HR = 1.268, p = 0.002). LASSO regression identified a multi-biomarker panel (MMP7, ICAM-1, CHI3L1, CA125) that differentiated progression more accurately than MMP7 alone. Furthermore, GAP combined with MMP7, ICAM-1, CCL18 and SP-D was more predictive of 3-year mortality than GAP alone.</p><p><strong>Conclusion: </strong>MMP7 along with a multi-biomarker and GAP panel can predict IPF progression and mortality, with the potential for optimising management.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"504-514"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371005","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":"Developments in Paediatric Interventional Pulmonology: Recent Experience in Turkiye With Broad Implications for the Field.","authors":"Aslı İmran Yılmaz, Dirk Schramm","doi":"10.1111/resp.70035","DOIUrl":"10.1111/resp.70035","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"535-536"},"PeriodicalIF":6.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658440","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}