Respirology最新文献

{"title":"Association of Airway Mucus Plugs and Physical Activity, Exercise Tolerance, Sarcopenia, and Frailty in Patients With COPD and Pre-COPD.","authors":"Yusuke Shiraishi, Naoya Tanabe, Tomoki Maetani, Yusuke Hayashi, Yohei Oshima, Yuji Yoshioka, Ryota Hamada, Ryo Sakamoto, Satoru Terada, Atsuyasu Sato, Susumu Sato, Toyohiro Hirai","doi":"10.1002/resp.70273","DOIUrl":"10.1002/resp.70273","url":null,"abstract":"<p><strong>Background and objective: </strong>Airway mucus plugs on computed tomography (CT) are an imaging biomarker of chronic obstructive pulmonary disease (COPD) associated with airflow limitation, respiratory symptoms, and poor prognosis. However, clinical phenotypes relevant to mucus plugs, including sarcopenia and frailty, are not fully elucidated. This study aimed to investigate the association between mucus plugs, sarcopenia, and frailty using a prospective observational COPD-enriched smoker cohort.</p><p><strong>Methods: </strong>In this cross-sectional analysis, patients with COPD and pre-COPD were classified into no-, low-, and high-mucus groups according to mucus scores on CT. The risks of frailty and sarcopenia, and relevant clinical, functional, and imaging factors including 6-min walk distance (6MWD), physical activity, body compositions via bioelectrical impedance analysis (BIA), and intra- and extrapulmonary CT indices were compared between groups.</p><p><strong>Results: </strong>Among 175 patients (142 COPD, 33 pre-COPD, and n = 106, 48, and 21 in the no-, low-, and high-mucus groups), the high-mucus group was associated with increased odds ratio for sarcopenia independent of age, sex, height, smoking, and forced expiratory volume in 1 s, or emphysema and wall area percentage (WA%). The high-mucus group demonstrated increased airtrapping and WA%, reduced total airway count, and decreased muscle and fat mass (assessed by both BIA and CT), while emphysema was not different. Furthermore, 6MWD deteriorated in the high-mucus group independent of age, sex, height, and smoking, whereas physical activity did not differ.</p><p><strong>Conclusion: </strong>In patients with COPD and pre-COPD, mucus plugs are associated with reduced muscle and fat mass and a heightened sarcopenia risk.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"893-902"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227680","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":"From Genomic Grouping to Clinical Meaning in Mycobacterium avium Lung Disease.","authors":"Yuuki Bamba, Kentaro Tanaka, Nobumasa Aoki","doi":"10.1002/resp.70308","DOIUrl":"https://doi.org/10.1002/resp.70308","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831867","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":"Inhaled Corticosteroid Escalation After a Single Moderate Exacerbation in COPD: Differential Benefit by Exacerbation Subtype.","authors":"Sun Hye Shin, Jihye Heo, Ji Ye Jung, Juhee Cho, Dave Singh, Danbee Kang, Hye Yun Park","doi":"10.1002/resp.70300","DOIUrl":"10.1002/resp.70300","url":null,"abstract":"<p><strong>Background and objective: </strong>In chronic obstructive pulmonary disease (COPD), evidence supporting escalation to inhaled corticosteroid (ICS)-containing therapy after single moderate exacerbation in patients receiving dual bronchodilator therapy remains inconsistent. We aimed to evaluate whether the clinical benefit of ICS escalation differs according to the treatment phenotype of moderate exacerbations.</p><p><strong>Methods: </strong>Using the Korean National Health Insurance Service database, we identified ICS-naïve patients with COPD initiating long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) therapy. Sequential target trial emulations were conducted among patients who experienced one moderate exacerbation while on LAMA/LABA. Exacerbations were classified as antibiotic-treated (without systemic corticosteroids) or systemic corticosteroid-treated (with or without antibiotics). Outcomes were compared between ICS escalation and LAMA/LABA continuation groups using propensity score matching.</p><p><strong>Results: </strong>Among 94,938 patients who initiated LAMA/LABA therapy, treatment persistence remained high, with over 60% maintaining dual therapy at 6 years, despite a marked decline in exacerbation-free survival. In matched analyses, ICS escalation after single antibiotic-treated exacerbations was not associated with reduced subsequent exacerbation risk. In contrast, among patients with steroid-treated moderate exacerbations, continuation of LAMA/LABA was associated with a higher risk of exacerbations (HR 1.18, 95% CI 1.12-1.23), compared with escalation to ICS-containing therapy. Findings were consistent across subgroups defined by exacerbation history.</p><p><strong>Conclusion: </strong>In this large real-world COPD cohort, the benefit of ICS escalation after single moderate exacerbation varied by exacerbation treatment phenotype. Steroid-treated events were associated with a reduced subsequent exacerbation with ICS escalation, whereas antibiotic-treated events did not confer additional benefit from ICS, supporting a more precise approach to ICS escalation beyond exacerbation frequency alone.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831921","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":"Pulmonary Rehabilitation in Acute Exacerbations of Interstitial Lung Disease: A Step in the Right Direction.","authors":"Leona Dowman","doi":"10.1002/resp.70306","DOIUrl":"https://doi.org/10.1002/resp.70306","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831895","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":"Comparison of Efficacy Between Non-Invasive Ventilation and High-Flow Nasal Cannula Oxygen Therapy in Treating Acute Pulmonary Edema.","authors":"Qiaoyun Huang, Jianyi Niu, Shanshan Zha, Zhenfeng He, Xueying Fan, Luqian Zhou, Rongchang Chen, Lili Guan","doi":"10.1002/resp.70304","DOIUrl":"https://doi.org/10.1002/resp.70304","url":null,"abstract":"<p><strong>Background and objective: </strong>Non-invasive ventilation (NIV) is the first-line treatment for acute pulmonary edema (APE). However, with the development of high-flow nasal cannula oxygen therapy (HFNC), recent small-sample prospective studies have suggested comparable efficacy between HFNC and NIV in treating acute cardiogenic pulmonary edema. To further evaluate the efficacy of these two respiratory support modalities, we directly compared their outcomes using data from two public databases, aiming to provide higher-quality evidence on the differences in benefit between the treatments.</p><p><strong>Methods: </strong>Patients diagnosed with APE and treated with NIV or HFNC were identified from the MIMIC-IV and eICU databases. Relevant demographics, vital signs, clinical outcomes, and other metrics were extracted. The primary outcome was the respiratory rate (RR) at 1 h post-treatment. The secondary outcomes were the 7-day intubation rate, 28-day mortality, and intensive care unit length of stay.</p><p><strong>Results: </strong>In total, 1180 patients were included in the study (161 in the HFNC group and 1019 in the NIV group). After propensity score matching, 158 patients were included in each group for analysis. There was no statistically significant difference in the RR at 1 h post-treatment between the NIV and HFNC groups (21 vs. 22 beats/min, p > 0.05). The 7-day intubation rate was significantly lower in the NIV group (8.23%; 13/158) than in the HFNC group (28.48%; 45/158) (p < 0.001).</p><p><strong>Conclusions: </strong>In this retrospective cohort study using propensity score matching, there was no statistically significant difference in RR at 1 h post-treatment between patients treated with HFNC or NIV for APE.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819157","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":"Post-Acute Sequelae of Non-COVID-19 Respiratory Viral Infections: A Systematic Review.","authors":"Esther Hui-En Chong, Ian Jun Yan Wee, Jenny Guek Hong Low, Paul Anantharajah Tambyah, Dorothy Hui Lin Ng","doi":"10.1002/resp.70302","DOIUrl":"https://doi.org/10.1002/resp.70302","url":null,"abstract":"<p><p>Respiratory viral infections (RVIs) affect millions annually, yet long-term consequences outside COVID-19 are poorly defined. Post-acute sequelae, encompassing persistent or new physical, cognitive, and mental health impairments, are increasingly recognised as clinically important. We systematically reviewed evidence on post-acute outcomes in adults following non-COVID RVIs to characterise pathogen-specific patterns and highlight areas for future research. Major databases were searched from January 2004 to August 2025 for observational studies reporting symptoms, functional impairment, or new diagnoses ≥ 4 weeks after RVIs. Study characteristics, pathogens, follow-up duration, and organ-specific outcomes were extracted. Risk of bias was evaluated using ROBINS-I, and certainty of evidence was determined with the GRADE approach. Narrative synthesis was performed owing to heterogeneity. Thirteen studies (n = 631,863) met eligibility criteria. Influenza was the most studied pathogen and consistently associated with long-term pulmonary dysfunction, reduced diffusion capacity, dyspnoea, fatigue, and poorer quality of life. Large cohorts corroborated substantial pulmonary morbidity and less frequent cardiovascular and neuropsychiatric burdens. Two RSV cohorts (n = 1553 and n = 471) showed a predominance of cardiovascular sequelae; respiratory and neurological outcomes were less frequent. A single HMPV cohort (n = 92) reported persistent symptoms in 55% of adults at 90-270 days, most commonly dyspnoea, fatigue, and cough. Overall, the available evidence suggests that non-COVID RVIs are associated with post-acute multi-organ sequelae, particularly following severe infection. Nevertheless, evidence remains fragmented due to inconsistent study designs, limited pathogen coverage, and low certainty. Standardised, prospective, pathogen-specific studies are required to refine these preliminary signals and inform clinical follow-up and prevention strategies.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797570","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":"CT-Based Biomarkers for Predicting Progressive Phenotypes in Interstitial Lung Diseases: A Retrospective Cohort Study.","authors":"Ju Hyun Oh, Jin Woo Song, Jonathan Goldin, S Samuel Weigt, Augustine Chung, Jared D Wilkinson, Fereidoun Abtin, Lila Pourzand, Bianca Villegas, Jihey Lee, Kyungjong Lee, Grace Hyun J Kim","doi":"10.1002/resp.70299","DOIUrl":"https://doi.org/10.1002/resp.70299","url":null,"abstract":"<p><strong>Background and objective: </strong>Prediction of the progressive phenotype from baseline evaluation is challenging due to the variable clinical course of fibrosing interstitial lung disease (ILD). The aim of this study was to evaluate whether the Single Time Point Prediction (STP) score predicts disease progression better than other quantitative scores.</p><p><strong>Methods: </strong>This is a retrospective two-centre study including patients with ILD other than idiopathic pulmonary fibrosis (IPF). Using an automated quantification system, quantitative lung fibrosis (QLF), quantitative ground-glass opacity (QGG), quantitative ILD (QILD; the sum of reticulation, honeycombing, and ground-glass opacity), quantitative normal lung (QNL), and STP scores were measured. Disease progression (DP) was defined as an absolute decline in forced vital capacity (FVC) ≥ 5% or DL_CO ≥ 10% predicted, death or lung transplantation.</p><p><strong>Results: </strong>Of 245 patients, 137 (55.9%) progressed during follow-up (median: 20.4 months). In the Kaplan-Meier analysis, patients with high QGG (≥ 10%), high QILD (≥ 30%), and high STP (≥ 30%) showed shorter DP free survival time than those without. After adjusting for age, sex, FVC, and types of non-IPF ILD, QGG scores ≥ 10%, QILD ≥ 30%, and STP ≥ 30% remained significant predictors of progression (hazard ratio [HR] = 1.71, p = 0.024; HR = 1.73, p = 0.006; and HR = 1.58, p = 0.020, respectively). Furthermore, higher QILD and QGG scores in STP-positive regions were independently associated with increased DP risk, whereas higher QNL in STP-negative regions was associated with lower DP risk.</p><p><strong>Conclusions: </strong>The STP score is a useful imaging biomarker for predicting DP and, when combined with conventional quantitative CT scores, may improve risk stratification in patients with non-IPF ILD.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760042","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":"From Pattern Recognition to Decision Guidance: Artificial Intelligence in Interstitial Lung Disease Diagnosis and Surveillance.","authors":"Deliang Yang, Xue Li, David Chi Leung Lam","doi":"10.1002/resp.70298","DOIUrl":"https://doi.org/10.1002/resp.70298","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713526","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":"Three Spirometry-Based At-Risk Phenotypes Predict Incident Airflow Limitation: A Population-Based Study.","authors":"Hendrik Pott, Roman Martin, Wilhelm Bertrams, Mustafa Abdo, Margit Heier, Annette Peters, Beate Stubbe, Max Kutzinski, Anne Obst, Ralf Ewert, Dominik Heider, Henry Völzke, Gernot Rohde, Claus F Vogelmeier, Bernd Schmeck, Stefan Karrasch","doi":"10.1002/resp.70296","DOIUrl":"https://doi.org/10.1002/resp.70296","url":null,"abstract":"<p><strong>Background and objective: </strong>Incident airflow limitation is frequently diagnosed at advanced stages. Identifying individuals at risk through primary care spirometry may enable earlier intervention, yet validated, pragmatic frameworks remain lacking.</p><p><strong>Methods: </strong>We applied a framework of three mutually exclusive spirometric at-risk phenotypes, termed Three-Phenotype Spirometry-Based Identification (hereafter TriSpi), to 6123 participants from two population-based cohorts: KORA (n = 1973, 3-year Follow-up, derivation) and SHIP (n = 4150, 5-year Follow-up, validation). TriSpi⁺ individuals were defined as meeting criteria for one of the three phenotypes: Early airflow limitation (EAL, FEV₁/FVC > 0.7 and < 10th percentile or < 0.7 and > 5th percentile), small airway dysfunction (SAD) defined using FEF₅₀- or FEF₇₅-based thresholds; and preserved-ratio impaired-spirometry (PRISm). Associations with incident airflow limitation were tested using Firth's regression.</p><p><strong>Results: </strong>EAL, PRISm, and SAD (defined using either FEF₅₀ or FEF₇₅-based thresholds) were significantly associated with incident airflow limitation across cohorts and follow-ups. TriSpi⁺ individuals accounted for 26%-36% of the population, identifying 74%-93% of future cases, while TriSpi⁺ was associated with a 10-25-fold increase in risk. Negative predictive values exceeded 95% across definitions, and the number needed to screen among TriSpi⁺ individuals ranged from 7 to 13. EAL showed the strongest individual association (OR up to 53.2), while SAD was more common in younger adults.</p><p><strong>Conclusion: </strong>Combining definitions for EAL, PRISm, and SAD enables robust prediction of incident airflow limitation. TriSpi may serve as a scalable, pragmatic approach for early risk stratification in primary care, in absence of post-BD spirometry.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707529","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":"Walking With Huffing: A Practical New Option for Airway Clearance During Bronchiectasis Exacerbations?","authors":"Xiu-Min Wu, Yong-Hua Gao","doi":"10.1002/resp.70268","DOIUrl":"10.1002/resp.70268","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"774-775"},"PeriodicalIF":7.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157915","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}