Respirology最新文献

{"title":"Enhancing Interstitial Lung Disease Diagnoses Through Multimodal AI Integration of Histopathological and CT Image Data.","authors":"Kris Lami, Mutsumi Ozasa, Xiangqian Che, Wataru Uegami, Yoshihiro Kato, Yoshiaki Zaizen, Naoko Tsuyama, Ichiro Mori, Shin Ichihara, Han-Seung Yoon, Ryoko Egashira, Kensuke Kataoka, Takeshi Johkoh, Yasuhiro Kondo, Richard Attanoos, Alberto Cavazza, Alberto M Marchevsky, Frank Schneider, Jaroslaw Wojciech Augustyniak, Amna Almutrafi, Alexandre Todorovic Fabro, Luka Brcic, Anja C Roden, Maxwell Smith, Andre Moreira, Junya Fukuoka","doi":"10.1111/resp.70036","DOIUrl":"10.1111/resp.70036","url":null,"abstract":"<p><strong>Background and objective: </strong>The diagnosis of interstitial lung diseases (ILDs) often relies on the integration of various clinical, radiological, and histopathological data. Achieving high diagnostic accuracy in ILDs, particularly for distinguishing usual interstitial pneumonia (UIP), is challenging and requires a multidisciplinary approach. Therefore, this study aimed to develop a multimodal artificial intelligence (AI) algorithm that combines computed tomography (CT) and histopathological images to improve the accuracy and consistency of UIP diagnosis.</p><p><strong>Methods: </strong>A dataset of CT and pathological images from 324 patients with ILD between 2009 and 2021 was collected. The CT component of the model was trained to identify 28 different radiological features. The pathological counterpart was developed in our previous study. A total of 114 samples were selected and used for testing the multimodal AI model. The performance of the multimodal AI was assessed through comparisons with expert pathologists and general pathologists.</p><p><strong>Results: </strong>The developed multimodal AI demonstrated a substantial improvement in distinguishing UIP from non-UIP, achieving an AUC of 0.92. When applied by general pathologists, the diagnostic agreement rate improved significantly, with a post-model κ score of 0.737 compared to 0.273 pre-model integration. Additionally, the diagnostic consensus rate with expert pulmonary pathologists increased from κ scores of 0.278-0.53 to 0.474-0.602 post-model integration. The model also increased diagnostic confidence among general pathologists.</p><p><strong>Conclusion: </strong>Combining CT and histopathological images, the multimodal AI algorithm enhances pathologists' diagnostic accuracy, consistency, and confidence in identifying UIP, even in cases where specialised expertise is limited.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"726-735"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773200","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":"Respiratory Nurse Leadership Requires Increased Profile, Role Clarity and Stronger Career Pathways: Binational Delphi Consensus Process and TSANZ Position Statement.","authors":"Rebecca Disler, Catherine Buchan, Nikola Ncube, Sharon Hancock, Ceri Banks, Kathy Chapman, Linda Geale, Brooke Kyle, Lena Ly, Alan Shaw, Betty Poot","doi":"10.1111/resp.70083","DOIUrl":"10.1111/resp.70083","url":null,"abstract":"<p><strong>Introduction/aim: </strong>The World Health Organisation recognises the integral role of respiratory nurses in the management and promotion of lung health to minimise substantial international health burden and health system costs. This Position Statement presents the Priorities for the Recognition of Respiratory Nursing as a Specific Field of Expertise, as validated through a binational Delphi consensus process, and endorsed by the Thoracic Society Australia and New Zealand Board on 25th October 2024.</p><p><strong>Methods: </strong>A cross-sectional online Delphi consensus survey delivered over two rounds using purposive sampling of leading respiratory nurse clinicians, managers, educators and/or researchers. In Round 1, participants rated generated priority statements on a 7-point Likert scale. In Round 2, mean item scores were provided and statements ranked to establish those of highest priority. Consensus cut-off was set at ≥ 75%.</p><p><strong>Results: </strong>One hundred and four Round 1 and sixty-four Round 2 participants from all Australian states and NZ regions confirmed 14 items, under three overarching priorities: the need to (1) raise the profile and influence of nurses within national and international respiratory organisations and policy; (2) define respiratory nursing as a field of specific expertise; and (3) articulate career progression and education frameworks as a roadmap to specialisation.</p><p><strong>Conclusion: </strong>Consensus on joint priorities supports respiratory nurses as integral to health strategy and articulates pathways for future workforce. Optimising the scope of nurses, including addressing barriers to contribution, and prioritisation and retention of specialist respiratory workforce, are necessary to meet population and health service demands and adequately support those living with lung conditions.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"705-714"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561000","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":"PMN-MDSCs Orchestrate the Immunosuppressive Microenvironment in the Lung and Are Associated With Clinical Outcome in Bronchiectasis.","authors":"Jielin Duan, Zhiwen Huang, Ying Jiang, Mo Xian, Wanjun Wang, Zhaowei Yang, Xu Shi, Nan Jia, Naijian Li, Bizhou Li, Zexuan Lian, Xiaoping Ning, Yubiao Guo, Haixiong Tang, Meihua Dong, Li He, Wenqing Yang, Renke Mo, Peiying Huang, Guan Yang, Ruchong Chen, LinLing Cheng, Jing Li","doi":"10.1111/resp.70045","DOIUrl":"10.1111/resp.70045","url":null,"abstract":"<p><strong>Background and objective: </strong>Myeloid-derived suppressor cells (MDSCs) participate in the progression of many diseases including chronic lung diseases. However, whether MDSCs are accumulated in the lung and how MDSCs orchestrate the pulmonary microenvironment in bronchiectasis remains unknown. Here, we aim to test a hypothesis that PMN-MDSCs are accumulated in the lung and play a role in creating an airway immunosuppressive milieu, thereby relating to clinical outcomes in bronchiectasis.</p><p><strong>Methods: </strong>Flow cytometry and immunofluorescence staining were performed for analysing the frequencies and presence of PMN-MDSCs, LOX-1⁺ neutrophils, and ARG-1⁺ PMN-MDSCs in PBMCs, sputum, and lung tissues. T-cell proliferation assays were established for evaluating the immunosuppressive activities of PMN-MDSCs. RNA sequencing was performed to investigate the underlying mechanism of PMN-MDSCs-mediated immunosuppression. The relationship of PMN-MDSCs with the time to next exacerbation and treatment response to antibiotic therapy was analysed.</p><p><strong>Results: </strong>PMN-MDSCs are accumulated in the lung and blood in bronchiectasis patients compared to healthy individuals. The majority of neutrophils in the lung of bronchiectasis patients are LOX-1⁺ PMN-MDSCs. Mechanistically, PMN-MDSCs suppress T cell proliferation via secreting high levels of the enzyme arginase-1 (ARG-1). Notably, the frequencies of PMN-MDSCs in sputum negatively correlate with the time to next exacerbation in bronchiectasis patients. Additionally, antibiotic therapy dramatically decreases PMN-MDSCs frequencies in the airway of bronchiectasis patients.</p><p><strong>Conclusion: </strong>These findings suggest that PMN-MDSCs accumulate and establish an immunosuppressive microenvironment in the lung via ARG-1 in bronchiectasis, which is associated with clinical outcome and response to antibiotic treatment, highlighting a potential role of PMN-MDSCs in bronchiectasis progression.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"715-725"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031993","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":"Artificial Intelligence and the Diagnosis of Interstitial Lung Disease: Are We Ready for ChatMDT?!","authors":"Toby M Maher","doi":"10.1111/resp.70056","DOIUrl":"10.1111/resp.70056","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"689-690"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064476","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":"How Do Governments Know What Needs Changing in Health Care?","authors":"Christine R Jenkins","doi":"10.1111/resp.70089","DOIUrl":"10.1111/resp.70089","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"781-782"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576206","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":"MetaNeb Versus Usual Care During Exacerbations of Cystic Fibrosis: An RCT.","authors":"Naomi Chapman, Vinicius Cavalheri, Elizabeth F Smith, Jamie Wood, Luke W Garratt, Siobhain Mulrennan, Anne Smith, Anna S Tai, Kylie Hill","doi":"10.1111/resp.70092","DOIUrl":"https://doi.org/10.1111/resp.70092","url":null,"abstract":"<p><strong>Background and objective: </strong>During exacerbations, when symptom and treatment burden are increased, individuals with cystic fibrosis (CF) are likely to prefer airway clearance techniques (ACTs) that require minimal effort. Therefore, in adults with CF who were hospitalised with an exacerbation, we sought to compare the effect of the MetaNeb with usual ACTs on respiratory function and expectorated sputum.</p><p><strong>Methods: </strong>This was a non-blinded randomised controlled trial where adults hospitalised with a CF exacerbation were allocated to an experimental intervention (EIx; MetaNeb) or a control intervention (CIx; their usual ACT). Both groups underwent twice-daily supervised airway clearance sessions, over an intervention period that ranged from 5 to 7 days during their hospitalisation. The primary outcome was ventilation inhomogeneity measured via lung clearance index (LCI) using the multiple breath washout technique. Secondary outcomes included adverse events, respiratory mechanics, forced expiratory volumes, sputum inflammatory markers, wellness, expectorated sputum, symptoms, participant satisfaction, and huff and cough counts.</p><p><strong>Results: </strong>Thirty participants were randomised (EIx group n = 14; CIx group n = 16). On completion of the intervention period, there was a greater improvement in LCI following the EIx than CIx (mean difference -0.84 units [-1.66 to -0.02], as well as some measures of respiratory mechanics. There were no between-group differences for the other secondary outcomes.</p><p><strong>Conclusion: </strong>In adults with CF who were hospitalised with an exacerbation, twice daily MetaNeb produced greater improvements in ventilation inhomogeneity compared to twice daily usual ACTs. There were no between-group differences shown for the other outcomes, including respiratory symptoms.</p><p><strong>Trial registration: </strong>Australian New Zealand Clinical Trials Registry (ACTRN12619001681145).</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733007","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":"Clinical Features Associated With Fatigue in People With Fibrotic Interstitial Lung Disease: Cross-Sectional Study.","authors":"Shohei Kawachi, Mariana Hoffman, Anne E Holland","doi":"10.1111/resp.70091","DOIUrl":"https://doi.org/10.1111/resp.70091","url":null,"abstract":"<p><strong>Background and objective: </strong>Fatigue significantly impacts quality of life in fibrosing interstitial lung diseases (fILDs). Oxyhaemoglobin desaturation contributes to fatigue in chronic obstructive pulmonary disease; however, this has not been investigated in fILD. This study aimed to elucidate the relationship between fatigue and clinical features, including oxyhaemoglobin desaturation, in fILD.</p><p><strong>Methods: </strong>Participants had stable fILD with exertional desaturation (SpO₂ ≤ 88% on 6-min walk test, 6MWT). Univariate and multivariate analyses were performed with fatigue as the dependent variable and the clinical features related to fatigue as independent variables. Fatigue was assessed using the Fatigue Severity Scale (FSS). Independent variables were specified a priori using directed acyclic graphs based on previous studies: age, BMI, severity (FVC%), Dyspnoea-12 score, physical activity (mean daily steps), desaturation (nadir SpO₂ during 6MWT and during daily life), presence of corticosteroids, and obstructive sleep apnoea.</p><p><strong>Results: </strong>One hundred and sixteen participants were included with mean (SD) age of 70.9 (9.8), FVC% of 69.8 (16.1). Seventy-two participants (62%) had substantial fatigue (≥ 36 on FSS). Univariate analysis showed no relationship between FSS and nadir SpO₂ during 6MWT (r = -0.03, p = 0.76) or minimum SpO₂ during daily life (r = 0.04, p = 0.74). Multiple regression analyses showed associations between higher fatigue on FSS and greater breathlessness on Dyspnoea-12 (standardised beta = 0.546, p < 0.001) and lower daily steps (standardised beta = -0.188, p = 0.02).</p><p><strong>Conclusion: </strong>Dyspnoea and physical activity are associated with fatigue in fILD. Exertional desaturation does not appear to contribute to fatigue in this group.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Registry (URL: https://clinicaltrials.gov/study/NCT03737409).</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675572","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":"Can Surface Ultrasound Be Used for the Serial Assessment of Tracheal and Subglottic Stenosis?","authors":"Ximena Cid-Serra, Colin Royse","doi":"10.1111/resp.70095","DOIUrl":"https://doi.org/10.1111/resp.70095","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643295","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":"NT-proBNP and BNP Testing in Pulmonary Arterial Hypertension: Point-of-Care and Remote Monitoring.","authors":"Charlotte Durrington, Christian Battersby, Laura Holt, Alexandra Fairman, Scarlett Strickland, Thomas Salisbury, Helena A Turton, Lisa Watson, Ian Smith, Stefan Roman, Jenna Ablott, Felicity Hitchcock, Chloe Roddis, Eleanor Oakes, Heather Wilshaw, Iain Woodrow, Iain Armstrong, Athanasios Charalampopoulos, Charlie A Elliot, Abdul Hameed, Neil Hamilton, Judith A Hurdman, Allan Lawrie, Jennifer T Middleton, Hamza Zafar, Alex M K Rothman, Robin Condliffe, Robert A Lewis, David G Kiely, A A Roger Thompson","doi":"10.1111/resp.70087","DOIUrl":"https://doi.org/10.1111/resp.70087","url":null,"abstract":"<p><strong>Background and objectives: </strong>Brain natriuretic peptide (BNP) and N-terminal prohormone of BNP (NT-proBNP) are important biomarkers in pulmonary arterial hypertension (PAH). However, results are rarely available at the time of clinical assessment. The reliability of NT-proBNP/BNP point-of-care tests (POCT) in PAH patients and the stability of NT-proBNP in posted blood samples, to simulate remote monitoring, was investigated.</p><p><strong>Methods: </strong>Group 1 PAH patients were prospectively recruited. A sample of 40 was required to demonstrate an intraclass correlation coefficient (ICC) of 0.94 with a 95% confidence interval width of < 0.1 for agreement between POCT and the laboratory standard. Blood samples were taken at two time-points for laboratory and POCT NT-proBNP/BNP. Separate samples were returned to the laboratory by post and some samples were assessed pre- and post-exercise assessing the impact of exercise.</p><p><strong>Results: </strong>Forty-one patients were enrolled with 56 study visits. NT-proBNP laboratory and POCT (n = 50) provided equivalent test results (Passing-Bablok slope = 1.08, CI = 0.97-1.19, intercept = 18.22, CI = -41.6 to 4.5) and ICC = 0.97. However, laboratory and POCT BNP (n = 49), showed non-equivalence (Passing-Bablok slope = 1.24, CI 1.11-1.31, intercept = -5.11, CI = -9.4 to -0.46), ICC = 0.96. POCT NT-proBNP/BNP correctly classified 92% and 86% of cases, respectively against COMPERA 2.0 4-risk-strata thresholds. NT-proBNP postal laboratory samples and immediately processed NT-proBNP laboratory samples showed good agreement and exercise had no clinically significant effect on NT-proBNP/BNP results. Laboratory BNP identified fewer patients as high risk compared to NT-proBNP. BNP and NT-proBNP risk status agreed at only 57% of visits (p < 0.0009).</p><p><strong>Conclusions: </strong>These data support the use of POCT NT-proBNP as a rapidly accessible and reliable alternative in clinical settings and highlight the potential of NT-proBNP for remote monitoring via posted samples.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov registration: NCT05421949.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560999","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":"Obstructive Sleep Apnoea Screening and Diagnosis Across Adult Populations: Are We Ready?","authors":"Nur K Abdul Jafar, Darren R Mansfield","doi":"10.1111/resp.70058","DOIUrl":"10.1111/resp.70058","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"555-557"},"PeriodicalIF":6.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079962","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}