Therapeutic Advances in Respiratory Disease最新文献

{"title":"Asthma and the risk of cardiovascular diseases and mortality: a meta-analysis of cohort studies.","authors":"Yuyue Jiang, Xuqing Huang, Dongwei Yu, Changqing Xu, Yan Wang, Xi Wang, Yuezhong Shen","doi":"10.1177/17534666251333965","DOIUrl":"https://doi.org/10.1177/17534666251333965","url":null,"abstract":"<p><strong>Background: </strong>It has been shown that asthma is potentially linked to a higher risk of cardiovascular disease (CVD) and cardiovascular mortality (CVM).</p><p><strong>Objectives: </strong>This study aims to systematically review and summarize epidemiological evidence on the relationship between asthma and these cardiovascular outcomes.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>This meta-analysis, registered with PROSPERO (CRD 42024576126), utilized data from PubMed, Embase, the Cochrane Library, and references from included studies. The search covered literature from the inception of these databases until July 17, 2024. We included observational studies examining the link between asthma and CVD and CVM. Bias risk was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). We calculated pooled relative risk (RR) with a 95% confidence interval (CI) using a random-effects model.</p><p><strong>Results: </strong>A total of 29 studies encompassing 11,380,027 participants were included. The overall risk for CVD in asthma patients was 1.30 (95% CI: 1.20-1.42). Specific CVD risks were elevated for coronary heart disease (CHD, RR 1.35; 95% CI: 1.27-1.42), angina pectoris (AP, RR 1.48; 95% CI: 1.16-1.89), myocardial infarction (MI, RR 1.33; 95% CI: 1.25-1.41), and heart failure (HF, RR 1.53; 95% CI: 1.04-2.23). Asthma was also associated with a higher risk of CVM (RR 1.26; 95% CI: 1.05-1.51).</p><p><strong>Conclusion: </strong>Asthma is associated with a higher risk of developing CVD, including specific types such as CHD, AP, MI, and HF. In addition, asthma patients face an increased risk of cardiovascular mortality compared to non-asthmatics.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251333965"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-led walking program before lung resection: a pilot study on feasibility and impact on quality of life.","authors":"Neelesh Bagrodia, Kyle Hansotia, Mahmoud Abdel-Rasoul, Desmond M D'Souza, Robert E Merritt, Peter J Kneuertz","doi":"10.1177/17534666251338391","DOIUrl":"10.1177/17534666251338391","url":null,"abstract":"<p><strong>Background: </strong>The role of preoperative conditioning on postoperative outcomes in thoracic surgery is of growing interest. There is a paucity of data on understanding compliance with a patient-led walking program and its impact on quality of life.</p><p><strong>Objectives: </strong>To understand the feasibility of patient-driven data collection of daily steps via pedometers and to understand the impact of preoperative conditioning on quality of life.</p><p><strong>Design: </strong>A prospective single-institution quality improvement study.</p><p><strong>Methods: </strong>The study included patients who underwent thoracic surgery between 2020 and 2022 who were and were selected to receive a pedometer at their preoperative clinic appointment. A daily step goal was determined, and patients were instructed to record their daily steps. Quality of life was assessed at baseline and at presentation for surgery. Clinical data and postoperative outcomes were derived from the institutional Society of Thoracic Surgery General Thoracic Surgery Database.</p><p><strong>Results: </strong>There were 167 patients provided with pedometers at their presurgical clinic appointment, of whom 43 returned pedometer data (utilization rate 26%). Of the 104 who underwent lung resection, 74 (44.3%) did not record step data, 15 had <6000 median daily steps, and 15 had >6000 median daily steps. Pre-intervention self-perceived outcomes were similar. Post-pedometer data demonstrated higher scores in the domains of general health (<i>p</i> = 0.016), quality of life (<i>p</i> = 0.03), general physical health (<i>p</i> = 0.002), physical performance (<i>p</i> = 0.03), social health (<i>p</i> = 0.009), social performance (p=0.01), and fatigue level (<i>p</i> = 0.01) for patients with higher median step counts. There were no significant differences in postoperative outcomes based on survival, length of stay (<i>p</i> = 0.77), or respiratory complications (<i>p</i> = 0.52).</p><p><strong>Conclusion: </strong>A patient-led walking program using pedometers is feasible for a minority of patients. Higher recorded daily step counts are associated with improved self-perceived quality of life in patients prior to lung surgery.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251338391"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophils in chronic obstructive pulmonary disease.","authors":"Marco Vanetti, Dina Visca, Francesco Ardesi, Martina Zappa, Patrizia Pignatti, Antonio Spanevello","doi":"10.1177/17534666251335800","DOIUrl":"10.1177/17534666251335800","url":null,"abstract":"<p><p>Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterised by chronic respiratory symptoms, fixed airway obstruction and persistent inflammation that leads to a progressive airflow limitation. Although COPD has traditionally been linked to neutrophilic inflammation, recent studies have identified a subset of patients - approximately 20%-40% - with elevated eosinophil levels in blood and sputum. Emerging evidence suggests that eosinophilic inflammation has a pivotal role in a subset of COPD patients and may influence disease progression, exacerbation frequency and therapeutic responses. This narrative review provides a comprehensive analysis of the role of eosinophils in COPD with particular attention to their role as biomarkers in blood and sputum. We evaluate the prevalence of eosinophilic inflammation in COPD exanimating different thresholds used in blood and in sputum to define it. In addition, we focus on eosinophilic COPD phenotype as a treatable trait, emphasising recent evidence that supports the effectiveness of biological target therapy.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251335800"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and prognostic trajectories of interstitial lung diseases after the multidisciplinary discussion.","authors":"Francesco Amati, Dean L Kellogg, Marcos I Restrepo, Francesco Blasi, Stefano Aliberti, Anoop M Nambiar","doi":"10.1177/17534666251323487","DOIUrl":"10.1177/17534666251323487","url":null,"abstract":"<p><strong>Background: </strong>The 2018 guidelines on the diagnosis of idiopathic pulmonary fibrosis (IPF) conditionally recommend multidisciplinary discussion (MDD) for diagnostic decision-making. However, limited data concerning the diagnostic impact of MDD on interstitial lung diseases (ILDs) are available.</p><p><strong>Objectives: </strong>The objective of this prospective study was to assess the impact of MDD at a tertiary referral ILD center on diagnostic trajectories, prognosis, and identification of potential treatable traits in ILD management.</p><p><strong>Design: </strong>This prospective study enrolled all consecutive adult ILD patients referred for MDD to a tertiary academic center in San Antonio, TX, USA from January 2017 to May 2020. The subjects were followed during a 3-year follow-up period after the MDD.</p><p><strong>Methods: </strong>Patients were stratified into three groups according to the pre-MDD diagnosis: unspecified ILD, IPF, and not IPF, and compared to the re-stratification post-MDD diagnosis into: unclassifiable ILD, IPF, and not IPF. The primary outcome was the percentage change in diagnostic trajectories after the MDD discussion.</p><p><strong>Results: </strong>A total of 201 ILD patients (61.7% male; mean (DS) age: 67.2 (10.4) years) were included in the study. The total diagnostic trajectory change occurred in 122 (60.7%) patients. The diagnostic trajectories changed in 40 (46.5%) patients in the IPF group and 8 (19.5%) in the non-IPF group (<i>p</i>-value = 0.0003). Patients with pre-MDD unspecified-ILD were classified as not-IPF in 32.4% (<i>n</i> = 24), IPF in 23% (<i>n</i> = 17), and unclassifiable-ILD in 44.6% (<i>n</i> = 33) post-MDD. Considering the post-MDD diagnosis, differences in mortality were detected among the three groups (<i>p</i> = 0.037).</p><p><strong>Conclusion: </strong>Our results suggest that MDD has a significant impact not only on the diagnostic trajectories (DT) but also on the prognosis of patients with ILDs.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251323487"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between early intubation and mortality in patients at high risk for noninvasive ventilation failure: a propensity-matched cohort study.","authors":"Tao Huang, Lijuan Chen, Xiaoyi Liu, Ke Wang, Weiwei Shu, Lei Jiang, Linfu Bai, Wenhui Hu, Mengyi Ma, Jun Duan","doi":"10.1177/17534666251347757","DOIUrl":"10.1177/17534666251347757","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive ventilation (NIV) is frequently employed for acute hypoxemic respiratory failure, yet optimal intubation timing for high-risk NIV failure patients remains uncertain.</p><p><strong>Objectives: </strong>To investigate mortality outcomes associated with early versus late intubation in high-risk NIV failure patients.</p><p><strong>Design: </strong>Secondary analysis of a multicenter observational cohort study.</p><p><strong>Methods: </strong>Patients with high NIV failure risk (updated HACOR score ⩾11 after 1-2 h of NIV) were enrolled. We defined that intubation was needed in these high-risk patients. Intubation occurring within 12 h of NIV initiation was classified as early intubation, while intubation after 12 h was designated as late intubation. Primary outcomes were intensive care unit (ICU) and hospital mortality. In sensitivity analyses, patients who achieved NIV success were categorized into the late-intubation group. Due to baseline imbalances, propensity score matching was performed with covariate adjustment.</p><p><strong>Results: </strong>Among the study population, 171 patients underwent early intubation and 222 underwent late intubation. Despite greater baseline severity in the early intubation group, ICU mortality (36% vs 58%, <i>p</i> < 0.001) and hospital mortality (38% vs 58%, <i>p</i> < 0.001) were significantly lower compared to the late-intubation group. In sensitivity analyses, 190 patients with NIV success were included in the late-intubation group, further accentuating the severity disparity between groups. After propensity matching (220 patients: 110 per group), most of the baseline characteristics were comparable. The early intubation group had a 100% intubation rate versus 71% in the late-intubation group, with the latter exhibiting higher mortality (ICU: 46% vs 32%, <i>p</i> = 0.052; hospital: 50% vs 34%, <i>p</i> = 0.020).</p><p><strong>Conclusion: </strong>In patients at high risk for NIV failure, early intubation is associated with reduced mortality.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251347757"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid microbial evaluation of acute exacerbations of bronchiectasis using FilmArray Pneumonia plus Panel in a real-world setting.","authors":"Charles Wong, Chun Wai Tong, Hei Shun Cheng, Pui Hing Chiu, Flora Pui Ling Miu, Yiu Wing Lam, Loretta Yin Chun Yam","doi":"10.1177/17534666251341751","DOIUrl":"10.1177/17534666251341751","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of bronchiectasis (AEB) are frequently caused by bacterial and/or viral infections. Rapid multiplex polymerase chain reaction (PCR) panels in respiratory specimens have significantly advanced microbial evaluation in patients with pneumonia. However, their clinical utility in patients with AEB remains unknown.</p><p><strong>Objectives: </strong>To investigate the microbial characteristics of AEB using FilmArray Pneumonia plus Panel (FAPP) and explore its clinical impact in a real-world setting.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>Spontaneous sputum samples of patients hospitalized for AEB were tested using FAPP in addition to standard-of-care testing. Microbial characteristics of AEB and the clinical impact of FAPP were evaluated.</p><p><strong>Results: </strong>Among 83 patients, FAPP detected ⩾1 bacterial pathogen(s) in 68 samples (81.9%), identifying 101 bacteria, with high abundance (10⁶ to ⩾10⁷ copies/ml) observed in 48 patients (57.8%). The most commonly detected bacteria were <i>Pseudomonas aeruginosa</i> (<i>Pa</i>) (37/83, 44.6%), <i>Staphylococcus aureus</i> (21/83, 25.3%), and <i>Haemophilus influenzae</i> (13/83, 15.7%). Respiratory viruses were identified in 21 patients (25.3), with <i>Influenza A</i> and <i>Respiratory syncytial virus</i> being the most common. Culture detected bacteria in significantly fewer samples (<i>n</i> = 25 [30.1%], <i>p</i> < 0.001). FAPP demonstrated 100% positive percent agreement and negative predictive value for all cultured bacteria, except for <i>Corynebacterium striatum</i> (<i>n</i> = 2), which was not included in the panel. FAPP shortened the time to bacterial results (mean: 10.8 h vs 70.8 h by culture, <i>p</i> < 0.001), and led to antimicrobial changes in 25 patients (30.1%) before the culture results were available. In multivariate analysis, chronic <i>Pa</i> infection (odds ratio (OR) 14.71), underweight status (OR 5.84), and cystic bronchiectasis (OR 5.26) were independent predictors of <i>Pa</i> detection by FAPP.</p><p><strong>Conclusion: </strong>The sputum multiplex PCR panel (FAPP) enables rapid identification of bacterial and viral pathogens in AEB, supporting early antimicrobial decision-making. Our findings highlight the potential utility of sputum multiplex PCR panels in improving the management of bronchiectasis exacerbations.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251341751"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New era, new GOALs: cardiovascular screening and lipid management in cystic fibrosis.","authors":"Katherine A Despotes, Agathe S Ceppe, Jennifer L Goralski, Scott H Donaldson","doi":"10.1177/17534666251317200","DOIUrl":"10.1177/17534666251317200","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) risks are increasing in people with cystic fibrosis (pwCF). While cholesterol levels were historically low in pwCF, higher levels after initiating highly effective modulator therapy (HEMT) have been reported. Mechanisms are unclear and there is little guidance on screening.</p><p><strong>Objectives: </strong>To evaluate serum lipid changes at multiple timepoints after ivacaftor initiation, and to assess current screening practices for CVD risk factors among CF providers.</p><p><strong>Design: </strong>This was a post-hoc correlative analysis of prospectively collected clinical data and serum samples from the GOAL cohort study. Cross-sectional survey methodology was also employed.</p><p><strong>Methods: </strong>We evaluated serum lipids (total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL)) at baseline, 3- and 18 months after ivacaftor initiation using samples from the GOAL study biorepository. We also surveyed CF providers across the United States on their CVD risk screening practices.</p><p><strong>Results: </strong>Fifty GOAL participants' samples were analyzed. Using the repeated measures model, TC significantly varied by visit (<i>p</i> = 0.004), driven by a significant increase from baseline at 3 months (mean difference 9.4 mg/dL). This difference diminished by 18 months. BMI was a significant covariate for TC. No significant differences by visit were detected in LDL or HDL. Seventy-five respondents participated in the survey (response rate 5.6%; 41 adult providers, 18 pediatric providers, and 10 providers caring for both) with 67% reporting no lipid screening policy existed in their center. In the past year, 29% of adult providers prescribed lipid-lowering therapy, 54% started anti-hypertensive medications, and 48% initiated ischemic cardiac evaluations for pwCF.</p><p><strong>Conclusion: </strong>TC significantly increased within 3 months of initiating ivacaftor, but subsequently diminished toward baseline by 18 months. Lipid screening practices among CF providers were variable and providers are increasingly being confronted with managing CVD risk factors. Partnering with primary care providers is likely to become increasingly important in CF care models.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251317200"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in acute COPD exacerbation: clarifying specific immune mechanisms of infectious and noninfectious factors.","authors":"Yadan Tu, Yong Chen, Xuanhan Li, Yigang Wang, Bangjiang Fang, Yi Ren, Chenghu Wang","doi":"10.1177/17534666241308408","DOIUrl":"10.1177/17534666241308408","url":null,"abstract":"<p><p>Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the main cause of hospitalization and death of patients with chronic obstructive pulmonary disease. This is largely due to bacterial resistance caused by clinical antibiotic abuse and the limited efficacy of current treatment strategies in managing noninfectious AECOPD, which presents a significant challenge for clinicians. Therefore, it is urgent for clinical treatment and prevention of AECOPD to fully understand the specific mechanism of AECOPD in the immune system and master the key differences between infectious factors and noninfectious factors. This article systematically discusses AECOPD triggered by various factors, including the activation of immune system, the recruitment and activation of inflammatory cells and the role of specific inflammatory responses, and through a comprehensive review of the literature, this article expounds the existing targeted diagnosis and treatment methods and technologies at different stages in order to provide new ideas and strategies for clinical prevention and treatment of AECOPD.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666241308408"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early, integrated palliative care for people with chronic respiratory disease: lessons learnt from lung cancer.","authors":"Anne M Walker, Donald R Sullivan, Phan Nguyen, Anne E Holland, Natasha Smallwood","doi":"10.1177/17534666241305497","DOIUrl":"10.1177/17534666241305497","url":null,"abstract":"<p><p>Lung cancer and chronic non-malignant respiratory disease cause pervasive, multifactorial suffering for patients and informal carers alike. Palliative care aims to reduce suffering and improve quality of life for patients and their families. An established evidence base exists that has demonstrated the essential role of specialist palliative care for people with lung cancer. Emerging evidence supports similar benefits among people with chronic respiratory disease. Many lessons can be learnt from lung cancer care, particularly as the model of care delivery has transformed over recent decades due to major advances in the diagnostic pathway and the development of new treatments. This narrative review aims to summarize the evidence for specialist palliative care in lung cancer and chronic respiratory disease, by highlighting seven key lessons from lung cancer care that can inform the development of proactive, integrated models of palliative care among those with chronic respiratory disease. These seven lessons emphasize (1) managing challenging symptoms; (2) the efficacy of specialist palliative care; (3) the importance of providing specialist palliative care integrated with disease-directed care according to patients' needs not prognosis; (4) the need for new models of collaborative palliative care, (5) which are culturally appropriate and (6) able to evolve with changes in disease-directed care. Finally, we discuss (7) some of the critical research gaps that persist and reduce implementation in practice.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666241305497"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From treatment to threat: the fatal impact of cumulative glucocorticoid dosage on outcomes in immunocompromised patients with community-acquired pneumonia.","authors":"Saibin Wang, Qian Ye, Yijun Sheng","doi":"10.1177/17534666251332085","DOIUrl":"https://doi.org/10.1177/17534666251332085","url":null,"abstract":"<p><strong>Background: </strong>Chronic glucocorticoid therapy is known to heighten the risk of secondary pulmonary infections. However, the impact of cumulative glucocorticoid dosage (CGD) on mortality risk in patients who develop community-acquired pneumonia (CAP) while undergoing glucocorticoid therapy remains inadequately explored.</p><p><strong>Objectives: </strong>This study aims to clarify the relationship between CGD and mortality outcomes in immunocompromised patients with CAP.</p><p><strong>Design: </strong>This study is a retrospective cohort analysis utilizing data from the DRYAD database.</p><p><strong>Methods: </strong>We examined data from 561 patients diagnosed with CAP who had received either oral or intravenous glucocorticoids prior to their CAP diagnosis. To evaluate the effect of CGD on mortality risk, we employed piecewise linear regression and Cox regression analyses, adjusting for relevant confounders.</p><p><strong>Results: </strong>Among the study population, the median CGD was 4 g of methylprednisolone (interquartile range 2.16-8.80 g). The 30-, 60-, and 90-day mortality rates were 22.28%, 25.13%, and 25.49%, respectively. Piecewise linear regression analysis revealed a nonlinear relationship between methylprednisolone dose and mortality risk, indicating a threshold effect at a methylprednisolone level of 20 g. In addition, Cox regression analysis showed a significantly higher mortality risk in patients with CGD exceeding 40 g of methylprednisolone compared to those with CGD between 20 and 40 g, after adjusting for potential confounding factors (adjusted HR 5.16, 95% CI: 1.16-22.99, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>CAP occurring in close proximity to recent high doses of steroids is associated with pathogens typically seen in immunocompromised hosts and is linked to higher mortality compared to usual CAP.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251332085"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}