Respirology最新文献

{"title":"Elevated MMP-9 Is Associated With Accelerated Lung Function Decline and COPD Development: A Prospective Cohort Study and Mendelian Randomisation Analysis.","authors":"Xinru Ran, Fan Wu, Zihui Wang, Haiqing Li, Zhishan Deng, Qiaorui Zhou, Huajing Yang, Youlan Zheng, Ningning Zhao, Cuiqiong Dai, Gaoying Tang, Xiaohui Wu, Qi Wan, Jieqi Peng, Lifei Lu, Kunning Zhou, Ge Bai, Jieda Cui, Yang Zhang, Maomao Ke, Wenya Han, Ruiting Sun, Pixin Ran, Yumin Zhou","doi":"10.1111/resp.70099","DOIUrl":"https://doi.org/10.1111/resp.70099","url":null,"abstract":"<p><strong>Background and objective: </strong>The imbalance in proteases/antiproteases caused by inflammation contributes to COPD, and matrix metalloproteinase-9 (MMP-9) may play an important role. Therefore, we aimed to investigate the associations of MMP-9 with respiratory health outcomes.</p><p><strong>Methods: </strong>This study was conducted in two parts. Firstly, we performed a prospective cohort study to investigate the association of circulating MMP-9 and respiratory health outcomes. Participants completed a questionnaire, spirometry, and chest CT, and provided blood samples at baseline. Follow-up visits were conducted annually. Study outcomes were the development of spirometry-defined COPD, lung function decline, and exacerbations. Secondly, we performed a two-sample Mendelian randomisation (MR) study to evaluate the causal effect between genetically predicted MMP-9 expression and lung function.</p><p><strong>Results: </strong>Overall, 1328 participants were included in the baseline analysis, and 1034 (78%) completed the 2-year follow-up. Higher plasma MMP-9 at baseline was associated with chronic respiratory symptoms, severe emphysema, and air trapping. During the 2-year follow-up, each SD increase in plasma MMP-9 was associated with accelerated decline in pre-bronchodilator FEV₁ (adjusted difference = 6.4 [95% CI: 0.7-12.1] mL/year) and FVC (adjusted difference = 18.0 [95% CI: 7.6-28.5] mL/year), and a higher exacerbation incidence. In participants with normal spirometry at baseline, higher plasma MMP-9 was associated with progression to spirometry-defined COPD (adjusted OR = 1.93, 95% CI: 1.05-3.57). A MR study demonstrated similar results toward negative associations of genetically predicted MMP-9 expression with FEV₁ and FVC.</p><p><strong>Conclusion: </strong>The longitudinal cohort and MR study provide evidence that MMP-9 might play a causative role in lung function decline and spirometry-defined COPD development.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789863","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":"Fenestrated vs. Conventional Silicone Stents in Benign Central Airway Stenosis: Clinical Outcomes and Biomechanical Validation.","authors":"Qixia Wang, Runchen Wang, Zhiming Ye, Junming Chen, Yihua Xu, Wenjun Ye, Shiyue Li, Yu Chen","doi":"10.1111/resp.70046","DOIUrl":"10.1111/resp.70046","url":null,"abstract":"<p><strong>Background and objective: </strong>Silicone stents are the gold standard for inoperable benign central airway stenosis but are often limited by complications. This study developed a self-made fenestrated silicone stent by perforating conventional stents and compared its efficacy with conventional stents.</p><p><strong>Methods: </strong>This retrospective study included 118 patients with benign central airway stenosis treated with fenestrated (n = 53) or conventional (n = 65) silicone stents between 2019 and 2023. Technical success, complication rate, patency time, and removal rate were compared between fenestrated and conventional cohorts using propensity score matching. Finite element analysis and computational fluid dynamics simulations were conducted to evaluate the equivalent stress, total deformation, static pressure, and turbulent intensity of fenestrated and conventional stents.</p><p><strong>Results: </strong>The PSM analysis included 35 patients with fenestrated stents and 35 with conventional stents. Stent insertion was successful in all cases. The cumulative incidence of overall complications (log-rank test p < 0.001), migration (log-rank test p = 0.006), granulation (log-rank test p = 0.006), and mucus retention (log-rank test p = 0.007) in the fenestrated group was significantly lower than in the conventional group. Fenestrated silicone stent was independently associated with a lower incidence of overall complications (adjusted hazard ratio (aHR) 0.23 [0.11-0.48]; p < 0.001), migration (aHR 0.15 [0.03-0.68]; p = 0.013), granulation (aHR 0.29 [0.13-0.63]; p = 0.002), and mucus retention (aHR 0.44 [0.20-0.94]; p = 0.034). Biomechanical analysis showed comparable equivalent stress and static pressure between fenestrated and conventional stents, while fenestrated stents exhibited increased localised flexibility and slightly higher turbulent intensity.</p><p><strong>Conclusion: </strong>Compared to conventional silicone stents, fenestrated stents offer longer patency, fewer complications, and improved biomechanical performance, without compromising the stent's structural integrity.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"751-759"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031029","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":"Simplifying CPAP Therapy: Is Fixed Pressure the Way Forward?","authors":"Ahmed S BaHammam","doi":"10.1111/resp.70042","DOIUrl":"10.1111/resp.70042","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"691-693"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051127","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":"Missing Millions With COPD.","authors":"John R Hurst","doi":"10.1111/resp.70082","DOIUrl":"10.1111/resp.70082","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"779-780"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529460","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 cmH ₂O May Replace Manual Titration in Moderate to Severe OSA Patients: A Preliminary Randomised Controlled Trial.","authors":"Lu Wang, Yan Chen, Qishan Wei, Yingxin Wu, Cuizhen Huang, Shanfeng Liang, Joerg Steier, Peter Catcheside, Danny Eckert, Andrew Wellman, Yuanming Luo","doi":"10.1111/resp.70037","DOIUrl":"10.1111/resp.70037","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patient compliance with continuous positive airway pressure (CPAP) is similar using manual-titrated pressure compared to auto-titration, although auto-titration pressures are usually 2-5 cmH₂O higher than manual pressure, indicating that CPAP moderately higher than the optimal pressure will not necessarily impair compliance. We try to find the tolerable highest CPAP which does not increase respiratory effort based on changes in lung volume, diaphragm electromyography (EMG) and breathing sensations in healthy volunteers and OSA patients to simplify pressure titration.</p><p><strong>Methods: </strong>Part 1, 12 healthy subjects and 16 OSA patients were enrolled in the measurement of expiratory reserve volume, diaphragm EMG, and expiratory muscle EMG at different CPAP levels. Breathing difficulty during different CPAP levels was assessed using a customised questionnaire in 35 healthy subjects and 33 OSA patients. Part 2, a two-night randomised crossover double-blind trial using the tolerable highest CPAP (10 cmH₂O) based on the results derived from Part 1 and the manually titrated pressure was performed in 25 OSA patients.</p><p><strong>Results: </strong>End expiratory lung volume increased significantly with increasing CPAP. In general, diaphragm EMG changed little when CPAP ≤ 10 cmH₂O. Expiratory muscle activity appeared when CPAP > 12 cmH₂O. There was no significant difference in subjective sensation of breathing difficulty with CPAP ≤ 10 cmH₂O. Sleep structure, AHI, and patient preference with 10 cmH₂O CPAP were not different from those under titrated pressure.</p><p><strong>Conclusions: </strong>This study suggests that most patients with moderate to severe OSA can be effectively treated with CPAP at an initial pressure of 10 cmH₂O without pressure titration.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04925466.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"770-778"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701383","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":"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":"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":"760-769"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321694/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter From Slovenia.","authors":"Ales Rozman","doi":"10.1111/resp.70075","DOIUrl":"10.1111/resp.70075","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"783-785"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326774","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":"Understanding Nontuberculous Mycobacterial Pulmonary Disease as a Chronic Lung Disease.","authors":"Hyung-Jun Kim, Jae-Joon Yim","doi":"10.1111/resp.70059","DOIUrl":"10.1111/resp.70059","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"694-696"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079967","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: New Techniques in Interventional Pulmonology.","authors":"Phan Nguyen, Pallav L Shah","doi":"10.1111/resp.70084","DOIUrl":"10.1111/resp.70084","url":null,"abstract":"<p><p>Navigational bronchoscopy and cone beam computed tomography (CBCT) guided bronchoscopy show comparable yields to percutaneous transthoracic needle biopsy of lung nodules. Robotic assisted bronchoscopy (RAB) with advanced imaging (CBCT or digital tomosynthesis) improves diagnostic yield further. Endobronchial ultrasound (EBUS) guided nodal cryobiopsy shows promise in certain clinical conditions. The thin EBUS convex probe (EBUS-CP) bronchoscope is on the horizon and has the potential to be the answer for the middle third. Guidelines and expert recommendations are sometimes needed where larger trial evidence may be lacking. Artificial intelligence is still finding its place in practice but shows promise for education and training.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"697-704"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592093","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":"Add-On Dextromethorphan Improves the Effects of Pirfenidone in Bleomycin-Treated Mice and Patients With Pulmonary Fibrosis.","authors":"Jie Huang, Nana Liu, Yueyue Jin, Shuangyu Han, Lian Li, Yunze Du, Luqing Wei, Dongsheng Li, Yan Zhang, Yubao Wang, Jau-Shyong Hong, Wen Ning, Jing Feng","doi":"10.1111/resp.70043","DOIUrl":"10.1111/resp.70043","url":null,"abstract":"<p><strong>Background and objective: </strong>Idiopathic pulmonary fibrosis is a progressive interstitial lung disease characterised by excessive activation of myofibroblasts. However, currently available antifibrotic drugs exhibit limited efficacy. The dysregulation of redox processes plays a significant role in the pathogenesis of idiopathic pulmonary fibrosis. Dextromethorphan (DM) is used in the treatment of various inflammation-related diseases. This study aimed to investigate the effectiveness of the combination of DM and pirfenidone (PFD) in treating idiopathic pulmonary fibrosis in both animal models and humans.</p><p><strong>Methods: </strong>In a bleomycin-induced pulmonary fibrosis mouse model, the anti-fibrotic effects of DM and/or PFD were assessed by evaluating fibrotic area, hydroxyproline levels, and fibrotic markers. In a transforming growth factor-β1-induced cell model, proliferation, migration, fibrosis markers, and oxidative stress were analysed to elucidate the mechanisms underlying the anti-fibrotic actions of DM and/or PFD. Finally, the efficacy of DM combined with PFD in patients with pulmonary fibrosis was evaluated by comparing pulmonary imaging scores and pulmonary function before and after treatment in the PFD group and the PFD + DM group.</p><p><strong>Results: </strong>We observed that even ultralow doses of DM, either alone or in combination with PFD, demonstrated substantial protective effects in mice. Notably, administration of DM or combined drugs at 2 weeks after bleomycin modelling still showed anti-fibrotic effects. In vitro, DM monotherapy and combination therapy restored the redox balance by suppressing nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4/reactive oxygen species production and upregulating superoxide dismutase, contributing to their anti-fibrotic mechanisms. In the clinical study, add-on DM improved PFD in mitigating pulmonary function decline and improving chest high-resolution computed tomography imaging scores.</p><p><strong>Conclusions: </strong>Ultralow doses of dextromethorphan significantly alleviate pulmonary fibrosis in bleomycin-treated mice through restoring the redox balance. Add-on DM improves the effects of PFD in both bleomycin-treated mice and patients with pulmonary fibrosis.</p><p><strong>Trial registration: </strong>ChiCTR2000037602.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"736-750"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014409","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}