Respirology最新文献

{"title":"Are We Closer to Predicting Radiological Progression Among ILD Patients?","authors":"Andrew Li, Tamera J Corte","doi":"10.1002/resp.70327","DOIUrl":"https://doi.org/10.1002/resp.70327","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081414","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":"Are Three Lung Function Risk Markers Better Than One?","authors":"Rosa Faner","doi":"10.1002/resp.70313","DOIUrl":"https://doi.org/10.1002/resp.70313","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012617","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":"Collaboration for Respiratory Health in Asia-Pacific: Renewing a Key Partnership.","authors":"Philip G Bardin, Christine F McDonald, Debra Sandford, Christine Jenkins, Paul Reynolds","doi":"10.1002/resp.70316","DOIUrl":"https://doi.org/10.1002/resp.70316","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012606","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 Cardiovascular Comorbidities on Clinical Outcomes Across the Asthma Spectrum.","authors":"Wen Wen Wu, Ji Wang, Wan An Qi Ma, Yan Li Huang, Xin Zhang, Min Xie, Chang Yong Wang, Woo-Jung Song, Ling Qin, Surinder S Birring, Zhi Hong Chen, Akio Niimi, Jie Zhang, Dan Liu, Vanessa M McDonald, Feng Min Luo, Peter Gerard Gibson, Wei Min Li, Kian Fan Chung, Gang Wang","doi":"10.1002/resp.70317","DOIUrl":"https://doi.org/10.1002/resp.70317","url":null,"abstract":"<p><strong>Background and objective: </strong>Cardiovascular disease (CVD) is a prevalent comorbidity in asthma, yet its impact on clinical outcomes across disease states remains poorly characterised.</p><p><strong>Methods: </strong>We analysed data from two independent prospective cohorts. Cohort I comprised 1058 stable asthma patients (CVD: n = 107; non-CVD: n = 951) followed for 12 months to assess asthma exacerbations. Cohort II comprised 825 patients hospitalised for an acute exacerbation (CVD: n = 233; non-CVD: n = 592). Missing data were handled by multiple imputation, and the CVD and non-CVD groups were balanced using propensity score overlap weighting. Associations were estimated using negative binomial, gamma, and logistic regression. Mediation and dominance analyses were performed as exploratory analyses.</p><p><strong>Results: </strong>Patients with CVD exhibited greater airflow obstruction and a predominantly non-T2 inflammatory profile characterised by increased neutrophilic inflammation. White blood cells, neutrophils, and monocytes partially mediated the association between CVD and lower FEV₁/FVC ratio, while monocytes additionally mediated the association between CVD and severe exacerbations. In Cohort I, CVD was independently associated with severe exacerbations (adjusted IRR = 1.96, 95% CI (1.12, 3.44)), hospitalisations, and emergency visits. In Cohort II, CVD was associated with longer hospital stay (adjusted IRR = 1.14, 95% CI (1.01, 1.30)) and higher direct costs, with stroke and coronary heart disease as leading contributors to prolonged stay.</p><p><strong>Conclusion: </strong>CVD is independently associated with worse clinical outcomes across the asthma disease spectrum. These findings support recognition of CVD as an important treatable trait in asthma and highlight the need for integrated cardiopulmonary management.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012590","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":"Safety and Efficacy of Direct Cryobiopsy Specimen Retrieval Through the 3.0-mm Working Channel of a Therapeutic Bronchoscope Using a 1.1-mm Cryoprobe: A Multicentre Prospective Observational Study.","authors":"Yuki Takigawa, Masahide Oki, Ken Sato, Suzuka Matsuoka, Atsushi Torii, Jun Nishimura, Yuka Shinohara, Hiromi Watanabe, Masahiro Sano, Kenichiro Kudo, Akiko Sato, Yoshihito Kogure, Keiichi Fujiwara, Takuo Shibayama","doi":"10.1002/resp.70314","DOIUrl":"https://doi.org/10.1002/resp.70314","url":null,"abstract":"<p><strong>Background and objective: </strong>Cryobiopsy using a 1.1-mm cryoprobe through a therapeutic bronchoscope with a 3.0-mm working channel permits en bloc retrieval of the cryoprobe and guide sheath while the bronchoscope remains wedged in the target bronchus, potentially facilitating immediate haemostatic control. This study investigated the safety and efficacy of this technique.</p><p><strong>Methods: </strong>This prospective observational study enrolled patients with peripheral pulmonary lesions suspected of lung cancer who underwent forceps biopsy (FB), followed by cryobiopsy using a 1.1-mm cryoprobe through a therapeutic bronchoscope with a 3.0-mm working channel. The primary endpoint was procedural safety, as assessed by bleeding grade. The secondary endpoints included procedure-related complications, diagnostic yield, specimen size, procedural success rate, and biomarker analysis success rate.</p><p><strong>Results: </strong>Of 100 enrolled patients, 96 were included in the analysis, and 84 underwent cryobiopsy. Bleeding severity was Grade 0 in 35.4% (34 of 96), Grade 1 in 41.7% (40 of 96), Grade 2 in 8.3% (8 of 96), and Grade 3 in 2.1% (2 of 96) of patients. Diagnostic yields were 77.0% (74 of 96) for FB and 79.1% (76 of 96) for cryobiopsy, with an overall yield of 87.5% (84 of 96). Cryobiopsy provided the sole diagnosis in 10 patients and yielded significantly larger specimens than FB (7.06 vs. 2.46 mm²; p < 0.001). The success rate of multiplex genetic testing was 95.8% for cryobiopsy (23 of 24).</p><p><strong>Conclusion: </strong>Direct retrieval of cryobiopsy specimens through the working channel of a therapeutic bronchoscope is safe and feasible, yielding larger specimens with complementary diagnostic value.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983542","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 Fibrotic Interstitial Lung Disease Outcomes: A Multicentre National Cohort Study.","authors":"Tyler Pitre, Christopher J Ryerson, Shaun Ong, Kerri A Johannson, Deborah Assayag, Veronica Marcoux, Martin Kolb, Helene Manganas, Daniel-Costin Marinescu, Jolene H Fisher","doi":"10.1002/resp.70305","DOIUrl":"https://doi.org/10.1002/resp.70305","url":null,"abstract":"<p><strong>Background and objective: </strong>This study determined contemporary transplant-free survival in fibrotic interstitial lung disease (ILD), identified baseline factors associated with death or transplant, and assessed performance of the ILD-GAP (Gender, Age, Physiology) index in a contemporary cohort.</p><p><strong>Methods: </strong>Patients with idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis (fHP), connective tissue disease-associated ILD (CTD-ILD), or unclassifiable ILD (uILD) prospectively enrolled in the Canadian Registry for Pulmonary Fibrosis were included. Transplant-free survival at 1, 3, and 5 years was estimated overall and by subtype using enrollment as time zero. Cox proportional hazards models evaluated associations between patient characteristics and time to death or transplant. ILD-GAP scores were calculated at 1, 2, and 3 years, and discriminability was assessed with Harrell's C statistic.</p><p><strong>Results: </strong>Among 4236 patients with fibrotic ILD enrolled in the Canadian Registry for Pulmonary Fibrosis (CARE-PF), 31% had IPF, 40% CTD-ILD, 9% fHP, and 20% uILD. Overall transplant-free survival was 91% at 1 year, 72% at 3 years, and 57% at 5 years. Survival was lowest in IPF (87%, 61%, 39%) and highest in CTD-ILD (95%, 81%, 70%). Compared with IPF, CTD-ILD was associated with better 5-year survival after adjustment (hazard ratio 0.64 [0.55-0.76]). ILD-GAP showed moderate discrimination at 1 (C = 0.75), 2 (C = 0.74), and 3 years (C = 0.73).</p><p><strong>Conclusion: </strong>In this registry cohort anchored at enrollment, CTD-ILD had superior transplant-free survival versus IPF, and ILD-GAP provided moderate prognostic accuracy.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907186","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":"Baseline Neutrophil-To-Lymphocyte Ratio as a Risk Stratification Marker for Severe Checkpoint Inhibitor Pneumonitis in Patients With Non-Small Cell Lung Cancer: A Two-Cohort Study With Retrospective Discovery and Prospective Validation.","authors":"Tetsu Hirakawa, Kakuhiro Yamaguchi, Shun Takao, Nobuhiro Kanaji, Naoko Matsumoto, Kozue Miyazaki, Tamio Okimoto, Chihiro Ando, Hisao Higo, Masaaki Yanai, Koji Kurose, Yasunari Nagasaki, Masako Watanabe, Kosuke Oyama, Yuko Toyoda, Yoshihiro Taguchi, Shimpei Tada, Kiyofumi Shimoji, Shinjiro Sakamoto, Yasushi Horimasu, Takeshi Masuda, Taku Nakashima, Hiroshi Iwamoto, Hironobu Hamada, Noboru Hattori","doi":"10.1002/resp.70267","DOIUrl":"10.1002/resp.70267","url":null,"abstract":"<p><strong>Background and objective: </strong>Severe checkpoint inhibitor pneumonitis (CIP), particularly when it develops within 6-12 weeks, is a potentially fatal adverse event in patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs). Although neutrophil-to-lymphocyte ratio (NLR) has been reported to predict immune-related adverse events, its role in severe CIP remains unclear.</p><p><strong>Methods: </strong>The discovery cohort retrospectively enrolled 102 patients with NSCLC treated with ICI monotherapy at Hiroshima University Hospital. The validation cohort prospectively enrolled 191 NSCLC patients receiving first-line treatment, including ICI, at 15 institutions. Severe CIP was defined as grade 3-5 pneumonitis occurring within 3 months of treatment initiation. The cut-off level of the baseline NLR was identified by receiver operating characteristic curve analysis in the discovery cohort, and the predictive accuracy was analyzed and confirmed in both cohorts.</p><p><strong>Results: </strong>Severe CIP was observed in seven (6.9%) and 11 (5.8%) patients in the discovery and validation cohorts, respectively. In the discovery cohort, the baseline NLR was higher in patients with severe CIP than in those without (17.29 [4.76-20.73] vs. 3.70 [2.64-6.68], p = 0.006), and the cut-off level of the baseline NLR was set at 4.75 (AUC 0.81; sensitivity 85.7%, specificity 64.2%). The incidence of severe CIP was significantly higher in patients with higher baseline NLR levels (≥ 4.75) than in those without, in both cohorts (discovery: 15.0% vs. 1.6%, p = 0.009; validation: 10.3% vs. 3.3%, p = 0.046).</p><p><strong>Conclusion: </strong>Baseline NLR is a promising risk stratification marker for severe CIP.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"922-932"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164218","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":"Update on the Pathophysiology, Aetiology and Management of Central Sleep Apnoea.","authors":"Sahan D Chandrasekara, Matthew T Naughton","doi":"10.1002/resp.70286","DOIUrl":"10.1002/resp.70286","url":null,"abstract":"<p><p>Central sleep apnoea (CSA) of the periodic breathing type occurs during the transition between wakefulness and stage 1 and 2 non-REM sleep. In adults at sea level, it occurs most commonly due to advanced heart failure (HF) or chronic opioid use and in ~5% of obstructive sleep apnoea patients initiating CPAP. The sudden development of CSA in a chronic CPAP user for obstructive sleep apnoea (OSA) may indicate the development of atrial fibrillation. Less commonly, idiopathic CSA occurs in which cardiac, neurological and endocrine causes should be excluded. Each cause of CSA has a characteristic appearance of apnoea, hyperpnoea and cycle length. Altitude induced CSA has recently been shown to reduce work of breathing whilst maintaining gas exchange, compared with regular breathing and thereby be considered adaptive rather than detrimental. The management of each type of CSA should be directed at the cause. Where there is residual CSA (e.g., post intensive treatment for HF), debate exists as to the next option. One argument is that CSA is adaptive (as seen with altitude) and therapeutic. An alternative argument is to treat the CSA directly with therapies such as respiratory stimulants (e.g., acetazolamide), positive airway pressure (e.g., adaptive servo-ventilation (ASV)), supplemental oxygen or phrenic nerve pacing. These four latter treatments remain speculative without strong foundations for recommending especially ASV in HF with reduced ejection fraction where increased mortality has been observed.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"873-881"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585117","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":"Few-Shot Lung Cancer Classification via Electronic Nose Using Large Language Models: A Multicentre Prospective Study.","authors":"Meng-Rui Lee, Chien-Chi Huang, Joyce Yue Sun, Chang-Ru Lin, Wen-Yuan Lin, Nai-Hui Chi, Kea-Tiong Tang, Jann-Yuan Wang, Chao-Chi Ho, Jin-Yuan Shih, Chong-Jen Yu","doi":"10.1002/resp.70266","DOIUrl":"10.1002/resp.70266","url":null,"abstract":"<p><strong>Background and objective: </strong>Electronic Nose (eNose) breathprints are promising non-invasive lung cancer diagnostic tools, but cross-site validation and adaptation remain barriers to clinical applications. It remains unknown whether a natural language processing-pretrained large language model (LLM) can enable few-shot, site-specific classification of lung cancer using eNose breathprints.</p><p><strong>Methods: </strong>We collected eNose breathprints of lung cancer and non-lung cancer patients from two medical centres in Taiwan. A GPT-2-backbone LLM with parameter-efficient adaptation was compared with convolutional neural networks (CNN) trained from scratch or pretrained on CIFAR-100. Few-shot protocols (2-6 shots per class) and full-data training were evaluated.</p><p><strong>Results: </strong>We collected 432 eNose breathprints from two sites (S1 and S2). With 6 labelled samples per class (6 shots), LLM achieved an area under the curve (AUC) of 0.79 (95% CI: 0.71-0.87), sensitivity of 0.74 (0.63-0.83), and specificity of 0.77 (0.67-0.87) on S1. On S2, it achieved an AUC of 0.76 (0.69-0.82), sensitivity of 0.77 (0.69-0.84), and specificity of 0.61 (0.51-0.70). LLM outperforms scratch CNN models (S1; AUC: 0.44, p = 0.0002) (S2; AUC: 0.63, p = 0.0198) and CNN pretrained on CIFAR-100 images (S1; AUC: 0.57, p = 0.0100) and (S2; AUC: 0.61, p = 0.0248). LLM or a CNN model trained on the source site fails to improve performance after transferring to the target site for fine-tuning; for the LLM, performance even deteriorates.</p><p><strong>Conclusion: </strong>Our study demonstrates the potential of pretrained LLMs for few-shot lung cancer classification in a real-world mixed clinical cohort, reducing dependence on large training datasets.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"912-921"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988710","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":"Clinical and Inflammatory Phenotypes During Exacerbations Predict In-Hospital Adverse Outcomes in Asthma-COPD Overlap.","authors":"Lishan Yuan, Lei Wang, Yulai Yuan, Yilai Li, Li Zhang, Ying Liu, Lei Liu, Lingyun Lu, Min Feng, Gang Wang, Shuwen Zhang, Chongyang Zhao, Qin Wang, Deying Kang, Xin Zhang","doi":"10.1002/resp.70275","DOIUrl":"10.1002/resp.70275","url":null,"abstract":"<p><strong>Background and objectives: </strong>Exacerbations of asthma-chronic obstructive pulmonary disease overlap (EACO) are associated with high mortality, yet the acute-phase heterogeneity remains poorly characterized. This study aimed to identify distinct inflammatory phenotypes of EACO during hospitalization and evaluate their associations with clinical outcomes.</p><p><strong>Methods: </strong>A prospective two-centre cohort study enrolled 2444 EACO patients (training and validation cohort). Baseline inflammatory markers and clinical data were collected. Unsupervised k-means clustering identified inflammatory phenotypes, with sensitivity analysis excluding demographic variables. In-hospital clinical outcomes (ICU admission, invasive ventilation, in-hospital mortality) were assessed. Logistic regression and causal mediation analysis evaluated phenotype-outcome associations. A nomogram was developed and validated using receiver operating characteristic curves (AUC).</p><p><strong>Results: </strong>Three distinct phenotypes were identified: Cluster T1 (neutrophil-to-lymphocyte ratio [NLR]-elevated hypoeosinophilic systemic inflammatory), Cluster T2 (eosinophilic), and Cluster T3 (eosinophil-neutrophil balanced). Cluster T1 exhibited systemic hyperinflammation (elevated white blood cell count, neutrophils, NLR, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)), and the highest composite adverse outcome rate (24.2%; p < 0.001). Logistic regression revealed absolute neutrophil count (β = 0.38, p < 0.001), D-dimer (β = 0.25, p < 0.001), and absolute lymphocyte count (β = -0.41, p < 0.001) as key outcome predictors, confirmed by causal mediation analysis. The nomogram showed robust predictive performance (AUC training = 0.775; validation = 0.766).</p><p><strong>Conclusion: </strong>Inflammatory phenotypes during EACO predict differential in-hospital outcomes, with neutrophil-dominant phenotypes conferring the highest risk. Early phenotype-based risk stratification using simple blood biomarkers may guide individualized EACO management.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"882-892"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309367","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}