Respirology最新文献

{"title":"The Overlap of Cardiac and Respiratory Disease.","authors":"Charles Feldman","doi":"10.1111/resp.14878","DOIUrl":"10.1111/resp.14878","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"192-195"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010451","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":"Fly Me to the Moon (or Not).","authors":"Natasha Smallwood","doi":"10.1111/resp.14886","DOIUrl":"10.1111/resp.14886","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"262-263"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053458","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":"Sputum metagenomics reveals a multidrug resistant Pseudomonas-dominant severe asthma phenotype in an Asian population.","authors":"Fransiskus Xaverius Ivan, Pei Yee Tiew, Tavleen Kaur Jaggi, Kai Xian Thng, Pee Hwee Pang, Thun How Ong, John Arputhan Abisheganaden, Mariko Siyue Koh, Sanjay H Chotirmall","doi":"10.1111/resp.14863","DOIUrl":"10.1111/resp.14863","url":null,"abstract":"<p><strong>Background and objective: </strong>While the lung microbiome in severe asthma has been studied, work has employed targeted amplicon-based sequencing approaches without functional assessment with none focused on multi-ethnic Asian populations. Here we investigate the clinical relevance of microbial phenotypes of severe asthma in Asians using metagenomics.</p><p><strong>Methods: </strong>Prospective assessment of clinical, radiological, and immunological measures were performed in a multi-ethnic Asian severe asthma cohort (N = 70) recruited across two centres in Singapore. Sputum was subjected to shotgun metagenomic sequencing and patients followed up for a 2-year period. Metagenomic assessment of sputum microbiomes, resistomes and virulomes were related to clinical outcomes.</p><p><strong>Results: </strong>The lung microbiome in a multi-ethnic Asian cohort with severe asthma demonstrates an increased abundance of Pseudomonas species. Unsupervised clustering of sputum metagenomes identified two patient clusters: C1 (n = 52) characterized by upper airway commensals and C2 (n = 18) dominated by established respiratory pathogens including M. catarrhalis, S. aureus and most significantly P. aeruginosa. C2 patients demonstrated a significantly increased exacerbation frequency on 2-year follow up and an antimicrobial resistome characterized by multidrug resistance. Virulomes appear indistinguishable between severe asthmatics with or without co-existing bronchiectasis, and C2 patients exhibit increased gene expression related to biofilm formation, effector delivery systems and microbial motility. Independent comparison of the C2 cluster to a non-asthmatic bronchiectasis cohort demonstrates analogous airway microbial virulence patterns.</p><p><strong>Conclusion: </strong>Sputum metagenomics demonstrates a multidrug-resistant Pseudomonas-dominant severe asthma phenotype in Asians, characterized by poor clinical outcome including increased exacerbations which is independent of co-existing bronchiectasis.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"217-229"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771999","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":"Sputum Metagenomics Reveals Multidrug-Resistant Pseudomonas-Dominant Communities in Severe Asthma.","authors":"Sara K Di Simone, Samuel C Forster","doi":"10.1111/resp.14890","DOIUrl":"10.1111/resp.14890","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"186-187"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081068","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":"Thoracic Society of Australia and New Zealand (TSANZ) Is Abrogating Its Leadership Role in Asia-Pacific.","authors":"Philip Bardin, Christine McDonald, Debra Sandford, Gregory King, Christine Jenkins, Paul Reynolds","doi":"10.1111/resp.14884","DOIUrl":"10.1111/resp.14884","url":null,"abstract":"","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"190-191"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010463","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":"Tuberculosis: An Update for the Clinician.","authors":"Saskia Janssen, Melissa Murphy, Caryn Upton, Brian Allwood, Andreas H Diacon","doi":"10.1111/resp.14887","DOIUrl":"10.1111/resp.14887","url":null,"abstract":"<p><p>Tuberculosis (TB) remains a significant global health threat with high mortality and efforts to meet WHO End TB Strategy milestones are off-track. It has become clear that TB is not a dichotomous infection with latent and active forms but presents along a disease spectrum. Subclinical TB plays a larger role in transmission than previously thought. Aerosol studies have shown that undiagnosed TB patients, even with paucibacillary disease, can be highly infectious and significantly contribute to TB spread. Encouraging clinical results have been seen with the M72/AS01_E vaccine. If preliminary results can be confirmed in ongoing larger trials, modelling shows the vaccine can positively impact the epidemic. TB preventive therapy (TPT), especially for high-risk groups like people living with HIV and household contacts of drug-resistant TB patients, has shown efficacy but implementation is resource intensive. Treatment options for infectious patients have grown rapidly. New shorter, all-oral treatment regimens represent a breakthrough, but progress is threatened by rising resistance to bedaquiline. Many new chemical entities are entering clinical trials and raise hopes for all-new regimens that could overcome rising resistance rates to conventional agents. More research is needed on the management of complex cases, such as central nervous system TB and severe HIV-associated TB. Post-TB lung disease (PTLD) is an under-recognised but growing concern, affecting millions of survivors with lasting respiratory impairment and increased mortality. Continued investment in development of TB vaccines and therapeutics, treatment shortening, and management of TB sequelae is critical to combat this ongoing public health challenge.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"196-205"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067554","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 digital therapy targeting anxiety in pulmonary fibrosis: A decentralized randomized controlled trial.","authors":"Joshua J Solomon, Robert W Hallowell, Cecilia Ganslandt, Jessica G Shull, Thomas Bengtsson, Jakob Ganslandt, Maureen R Horton","doi":"10.1111/resp.14859","DOIUrl":"10.1111/resp.14859","url":null,"abstract":"<p><strong>Background and objective: </strong>Pulmonary fibrosis, a manifestation of interstitial lung disease, is frequently associated with anxiety. The objective of this study, COMPANION, was to assess the anxiolytic efficacy of Almee, a digital cognitive behavioural therapy for patients with pulmonary fibrosis, compared to treatment as usual.</p><p><strong>Methods: </strong>COMPANION was a randomized, controlled, open-label and partly reader-blinded, decentralized, clinical trial conducted in the United States. Eligible patients had radiology-confirmed pulmonary fibrosis and a Generalized Anxiety Disorder 7-item (GAD-7) score of ≥5 (possible range 0-21). Participants were randomized 1:1 to Almee or no intervention for 9 weeks, with block stratification by anxiety severity. The primary endpoint was change in GAD-7 score from baseline to week 9. Between 20 December 2022 and 14 August 2023, 108 participants were randomized, 54 to Almee and 54 to treatment as usual.</p><p><strong>Results: </strong>In each arm, 46 participants completed the study; 108 cases were analysed as intention-to-treat. By week 9, average GAD-7 score had improved by 1.8 points (SEM = 2.1) in the Almee group (n = 54) and deteriorated by 0.9 points (SEM = 2.2) in the control group (n = 54), a 2.7-point difference (95% confidence interval: 1.2-4.2, p = 0.0006).</p><p><strong>Conclusion: </strong>Treatment with Almee was well-tolerated and showed clinically meaningful improvement in pulmonary fibrosis-related anxiety. Almee shows promise as a personalized intervention for management of the psychological burden related to living with pulmonary fibrosis.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":"253-261"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771997","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":"Development and Validation of a Risk Prediction Model to Identify Women With Chronic Obstructive Pulmonary Disease for Proactive Palliative Care.","authors":"Begashaw Melaku Gebresillassie, John Attia, Dominic Cavenagh, Melissa L Harris","doi":"10.1111/resp.70005","DOIUrl":"https://doi.org/10.1111/resp.70005","url":null,"abstract":"<p><strong>Background and objective: </strong>Proactive palliative interventions can improve symptom control and quality of life in individuals with chronic obstructive pulmonary disease (COPD); however, they are often underutilised. This study aimed to develop and validate a prediction model to identify women with COPD in their last year of life to facilitate timely palliative care referrals and interventions.</p><p><strong>Methods: </strong>Data from 1236 women diagnosed with COPD from the 1921-1926 Australian Longitudinal Study on Women's Health cohort, linked to administrative health records, were analysed. We employed Lasso regression and multivariable logistic regression to select predictors. To assess the predictive performance of the model, we used the area under the receiver operating characteristic (AUROC) curve, calibration plot, and calibration metrics. The Youden index was used to establish the optimal cutoff point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA).</p><p><strong>Results: </strong>The final model to predict 1-year all-cause mortality included six predictors: smoking status, body mass index, needing regular assistance with daily activities, number of supplied medications, duration of illness, and number of hospital admissions. The model performed well, with AUROC of 0.82 (95% CI: 0.80-0.85) and showed excellent calibration. Using a cutoff of 56.6% predicted risk, the model achieved a sensitivity of 72.3%, specificity of 77.7%, and accuracy of 75.0%. The DCA indicated that the model provided a greater net benefit for clinical decision-making.</p><p><strong>Conclusion: </strong>Our prediction model for identifying women with COPD who may benefit from palliative care has shown robust predictive performance and can be easily applied, but requires external validation.</p>","PeriodicalId":21129,"journal":{"name":"Respirology","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433434","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":"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":"https://doi.org/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":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}