Therapeutic Advances in Respiratory Disease最新文献

{"title":"Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study.","authors":"Wen Zhang, Xiaohong Yuan, Yajian Shen, Jiangling Wang, Kangjie Xie, Xinzhong Chen","doi":"10.1177/17534666241246637","DOIUrl":"https://doi.org/10.1177/17534666241246637","url":null,"abstract":"<p><strong>Background: </strong>Although high-flow nasal cannula (HFNC) oxygenation is currently recommended to prevent desaturation during sedation for bronchoscopy, there is no consensus on an optimal flow rate.</p><p><strong>Objective: </strong>To determine the optimal oxygen flow rate for HFNC to effectively prevent desaturation during sedation for bronchoscopy.</p><p><strong>Design: </strong>Prospective, randomized, and controlled study.</p><p><strong>Methods: </strong>Patients (<i>n</i> = 240) scheduled for bronchoscopy were randomized to receive HFNC with propofol sedation (fraction of inspired oxygen, 100%) at one of six flow rates of 10, 20, 30, 40, 50, and 60 L/min, designated as groups 1-6, respectively.</p><p><strong>Results: </strong>The incidence of desaturation significantly decreased by increasing the oxygen flow rate (42.5%, 17.5%, 15%, 10%, 2.5%, and 0% for groups 1-6, respectively, <i>p</i> < 0.0001). The optimal oxygen flow rate for HFNC determined by probit regression to effectively prevent desaturation in 95% of patients was 43.20 (95% confidence interval, 36.43-55.96) L/min. The requirement for airway intervention was significantly decreased by increasing the oxygen flow rate.</p><p><strong>Conclusion: </strong>An HFNC flow rate of 50-60 L/min is recommended to prevent desaturation during sedation for bronchoscopy.</p><p><strong>Registration: </strong>NCT05298319 at ClinicalTrials.gov.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241246637"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868667","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":"Building and validating an artificial intelligence model to identify tracheobronchopathia osteochondroplastica by using bronchoscopic images.","authors":"Chongxiang Chen, Fei Tang, Felix J F Herth, Yingnan Zuo, Jiangtao Ren, Shuaiqi Zhang, Wenhua Jian, Chunli Tang, Shiyue Li","doi":"10.1177/17534666241253694","DOIUrl":"10.1177/17534666241253694","url":null,"abstract":"<p><strong>Background: </strong>Given the rarity of tracheobronchopathia osteochondroplastica (TO), many young doctors in primary hospitals are unable to identify TO based on bronchoscopy findings.</p><p><strong>Objectives: </strong>To build an artificial intelligence (AI) model for differentiating TO from other multinodular airway diseases by using bronchoscopic images.</p><p><strong>Design: </strong>We designed the study by comparing the imaging data of patients undergoing bronchoscopy from January 2010 to October 2022 by using EfficientNet. Bronchoscopic images of 21 patients with TO at Anhui Chest Hospital from October 2019 to October 2022 were collected for external validation.</p><p><strong>Methods: </strong>Bronchoscopic images of patients with multinodular airway lesions (including TO, amyloidosis, tumors, and inflammation) and without airway lesions in the First Affiliated Hospital of Guangzhou Medical University were collected. The images were randomized (4:1) into training and validation groups based on different diseases and utilized for deep learning by convolutional neural networks (CNNs).</p><p><strong>Results: </strong>We enrolled 201 patients with multinodular airway disease (38, 15, 75, and 73 patients with TO, amyloidosis, tumors, and inflammation, respectively) and 213 without any airway lesions. To find multinodular lesion images for deep learning, we utilized 2183 bronchoscopic images of multinodular lesions (including TO, amyloidosis, tumor, and inflammation) and compared them with images without any airway lesions (1733). The accuracy of multinodular lesion identification was 98.9%. Further, the accuracy of TO detection based on the bronchoscopic images of multinodular lesions was 89.2%. Regarding external validation (using images from 21 patients with TO), all patients could be diagnosed with TO; the accuracy was 89.8%.</p><p><strong>Conclusion: </strong>We built an AI model that could differentiate TO from other multinodular airway diseases (mainly amyloidosis, tumors, and inflammation) by using bronchoscopic images. The model could help young physicians identify this rare airway disease.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241253694"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11131396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157249","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":"Prescriptions of opioid-containing drugs in patients with chronic cough.","authors":"Michael Weiner, Ziyue Liu, Jonathan Schelfhout, Paul Dexter, Anna R Roberts, Ashley Griffith, Vishal Bali, Jessica Weaver","doi":"10.1177/17534666241259373","DOIUrl":"10.1177/17534666241259373","url":null,"abstract":"<p><strong>Background: </strong>Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.</p><p><strong>Objectives: </strong>To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's <i>t</i>-test, Pearson's chi-square, and zero-inflated Poisson models were used.</p><p><strong>Results: </strong>About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance.</p><p><strong>Conclusion: </strong>Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241259373"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321696","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":"Observational study on the prescription practices of family and pulmonary physicians for airway clearance devices in chronic obstructive pulmonary disease management.","authors":"Saeed Mardy Alghamdi, Abdulaziz A Alzahrani, Mohammad S Dairi, Hassan Alwafi, Abdulelah M Aldhahir, Jaber S Alqahtani, Mohammed M Alqahtani, Abdullah M Alanazi, Abdullah A Alqarni, Rayan A Siraj, Noha Saeed Alghamdi, Hassan A Alzahrani, Abdulghani A Alhindi","doi":"10.1177/17534666241307066","DOIUrl":"10.1177/17534666241307066","url":null,"abstract":"<p><strong>Background: </strong>Productive cough with sputum is a prominent sign generally associated with respiratory diseases, including chronic obstructive pulmonary disease (COPD). Airway clearance devices are an option for COPD management, but physicians' preferences for and clinical practice with them are not known.</p><p><strong>Objective: </strong>This study aims to explore preferences for and clinical practice with airway clearance devices among physicians in Saudi Arabia.</p><p><strong>Design: </strong>An observational, cross-sectional survey.</p><p><strong>Methods: </strong>A self-administered questionnaire was conducted between October 2022 and September 2023, which included a review of respiratory medication prescriptions by physicians for patients with COPD. The analysis was performed using the Statistical Package for the Social Sciences.</p><p><strong>Results: </strong>The participants were 445 physicians. The majority were female, accounting for 64.3% of the sample. Flutter and Acapella were the most commonly preferred airway clearance devices (45.8% and 20.7%, respectively). Among the participants, 12.6% reported unfamiliarity with any of the mentioned devices. Of the participants, 43.6% \"usually\" suggested the devices for patients with daily, difficult-to-clear, thick sputum, while 27% \"sometimes\" recommended them to COPD patients who had experienced four exacerbations or more. In routine clinical practice, physicians prescribe pharmacological therapies as the main treatment. The prescribing data showed that in the last year, there was no record of prescribed airway clearance devices for COPD by physicians.</p><p><strong>Conclusion: </strong>Family and pulmonary physicians prefer Flutter and Acapella devices, but a significant number of physicians are unaware of such devices. Prescribing data showed no record of prescribed airway clearance devices for COPD management. Further initiatives are needed to increase awareness in clinical practice.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241307066"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829950","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":"A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold.","authors":"Martina Hagen, Kim Clark, Pranab Kalita, Gessica Serra, Edwin Sanchez, Gabor Varbiro, Mathieu M Albasser","doi":"10.1177/17534666241228927","DOIUrl":"10.1177/17534666241228927","url":null,"abstract":"<p><strong>Background: </strong>The common cold is a frequent, acute, and mild upper respiratory human disease. Nasal congestion has been considered the most bothersome symptom in the common cold, impacting quality of life (QoL). Topical decongestants containing steroids benefit QoL in allergic rhinitis, but no published research has assessed the impact of topical decongestants on QoL in the common cold.</p><p><strong>Objective: </strong>To evaluate the effects of xylometazoline hydrochloride 0.1% (Otrivin, GSK Consumer Healthcare SARL, Switzerland) for up to 7 days on QoL in participants with nasal congestion associated with the common cold.</p><p><strong>Design: </strong>This was a decentralized, longitudinal, open-label study.</p><p><strong>Methods: </strong>The study enrolled 136 participants (⩾18 years) with early symptoms of the common cold, of which 102 were included in the modified intention-to-treat (mITT) population. Within 24 h of study product receipt, participants confirmed a 'plugged nose' and ⩾1 other common cold symptom. Primary endpoints were Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) total score, total and individual symptom scores, and total QoL score. Secondary endpoints were additional QoL scores. Exploratory and <i>post hoc</i> analyses included median days to resolution for each QoL factor and analyses of five QoL categories.</p><p><strong>Results: </strong>Consistent improvements in symptoms and QoL were seen in the mITT population. From day 1, improvements were seen in the 'plugged nose' symptom (<i>p</i> = 0.0023), WURSS-21 total QoL score, and all individual QoL scores (<i>p</i> < 0.0001 for all). After the last dose needed, significant improvements were seen in sleep quality (73%), vitality (76%), physical activity (71%), social activity (80%), and sensation (81%). No serious or unexpected adverse events were reported.</p><p><strong>Conclusion: </strong>This study is the first to demonstrate in a real-life setting that treating nasal congestion in adults with xylometazoline hydrochloride 0.1% during the common cold positively impacts QoL factors relevant to daily living [Otrivin: Quality of Life (QoL) Impact in a Real-World Setting; https://clinicaltrials.gov/study/NCT05556148].</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241228927"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10878222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900479","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":"Patients' perspectives on the challenges associated with receiving non-oral pulmonary arterial hypertension treatment: a mixed methods study.","authors":"Aldo Aguirre-Camacho","doi":"10.1177/17534666241289807","DOIUrl":"10.1177/17534666241289807","url":null,"abstract":"<p><strong>Background: </strong>Impaired quality of life (QoL) among pulmonary arterial hypertension (PAH) patients has been often attributed to increased symptomatology, functional disability, and poor mental health; however, the unique impact that PAH treatments may exert on the daily lives of patients remains underexplored.</p><p><strong>Objectives: </strong>To gain insight into the day-to-day challenges associated with receiving non-oral PAH treatments, and the specific impact these may exert on patients' QoL, above and beyond that exerted by PAH itself.</p><p><strong>Design: </strong>Explanatory sequential mixed methods design.</p><p><strong>Methods: </strong>Eighty-three PAH patients provided information on demographic and clinical characteristics, and completed measures of symptomatology, functional disability, QoL, psychological well-being, and perceived stress. Nine of these patients also participated in a focused group discussion and interviews.</p><p><strong>Results: </strong>No group differences in symptomatology and functional disability were observed between patients receiving oral-only and non-oral PAH therapy; however, patients on non-oral therapy reported poorer QoL, after taking into consideration the effect of relevant covariates (i.e., age, level of symptomatology and functional disability, psychological well-being, and perceived stress) that could have confounded the observed group differences in QoL. Participants who started on non-oral medications acknowledged they had experienced significant improvements in health status. However, they also stated that transitioning from oral to non-oral therapy elicited great apprehension and that non-oral therapy regimens interfered with daily activities, resulted in added difficulties for self-management, and negatively impacted their subjective well-being.</p><p><strong>Conclusion: </strong>Non-oral therapy regimens may pose challenges beyond those posed by PAH itself, potentially resulting in an added burden to the QoL of PAH patients.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241289807"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682854","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":"Procedural times with robotic-assisted bronchoscopy: a high volume single-center study.","authors":"Kim Styrvoky, Audra Schwalk, David Pham, Kristine Madsen, Hsienchang Chiu, Muhanned Abu-Hijleh","doi":"10.1177/17534666241277668","DOIUrl":"10.1177/17534666241277668","url":null,"abstract":"<p><strong>Background: </strong>Incidental and screen-detected pulmonary nodules are common. The increasing capabilities of advanced diagnostic bronchoscopy will increase bronchoscopists' procedural volume necessitating optimization of procedural scheduling and workflow.</p><p><strong>Objectives: </strong>The objectives of this study were to determine total time in the procedure room, total bronchoscopy procedure time, and robotic-assisted bronchoscopy procedure time longitudinally and per specific procedure performed.</p><p><strong>Design: </strong>A single-center observational study of all consecutive patients undergoing shape-sensing robotic-assisted bronchoscopy (RAB) biopsy procedures for the evaluation of pulmonary lesions with variable probability for malignancy.</p><p><strong>Methods: </strong>Chart review to collect patient demographics, lesion characteristics, and procedural specifics. Descriptive and comparative statistics are reported.</p><p><strong>Results: </strong>Actual bronchoscopy procedure time may decrease with increased institutional experience over time, however, there is limited ability to reduce non-bronchoscopy related time within the procedure room. The use of cone beam computed tomography (CBCT), rapid on-site evaluation (ROSE), and performance of staging endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in a single procedure are each associated with additional time requirements.</p><p><strong>Conclusion: </strong>Institutional procedural block times should adapt to the nature of advanced diagnostic bronchoscopy procedures to allow for the accommodation of new modalities such as RAB combined with other technologies including radial endobronchial ultrasound, CBCT, ROSE, and staging linear EBUS. Identifying institutional median procedural times may assist in scheduling and ideal block time utilization.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241277668"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133873","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":"Comparative yield of EBUS-TBNA with EBUS-IFBTLP for diagnosis of mediastinal lymphadenopathy.","authors":"Rui Zhang, Wenping Zhang, Xiangsong Cheng, Dan Si, Bao Liu, Xingang Hu, Xianliang Chen, Zhuquan Su","doi":"10.1177/17534666241282217","DOIUrl":"10.1177/17534666241282217","url":null,"abstract":"<p><strong>Background: </strong>Patients with mediastinal lymph node enlargement (MLNE) are diagnosed depending on lymph node biopsy. Whereas, how to obtain larger tissue masses from mediastinal lymph nodes and improve the diagnostic yield of the disease remains to be investigated.</p><p><strong>Objectives: </strong>Aiming to assess the diagnostic value of endobronchial ultrasound-guided intranodal forceps biopsy via transbronchial laser photoablation (EBUS-IFB-TLP) in patients with MLNE.</p><p><strong>Design: </strong>A prospective, self-controlled study.</p><p><strong>Methods: </strong>This study was conducted on 67 MLNE patients requiring a lymph node biopsy for diagnosis at the Henan Provincial People's Hospital and the Fuwai Central China Cardiovascular Hospital in China, from January 2020 to December 2022. Each patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA group) and EBUS-IFB-TLP (EBUS-IFB-TLP group) on the same mediastinal lymph node for biopsies. The operation time, diagnostic efficiency, and complication rates of the two biopsy methods were compared.</p><p><strong>Results: </strong>The number of diagnosed patients in the EBUS-IFB-TLP and the EBUS-TBNA groups was 65 (97.0%) and 57 (85.1%), respectively (<i>p</i> = 0.021). In the EBUS-IFB-TLP group, 28 cases (96.6%) were diagnosed with lung cancer and were classified into different epithelial types. In the EBUS-TBNA group, there were 27 cases (93.1%) diagnosed with lung cancer, of which 26 (89.7%) were classified into different epithelial types. There were 37 (97.4%) and 30 (78.9%) non-lung cancer patients diagnosed in the EBUS-IFB-TLP and EBUS-TBNA groups, respectively (<i>p</i> = 0.039), while 27 cases (96.4%) of sarcoidosis in the EBUS-IFB-TLP group and 20 cases (71.4%) of sarcoidosis in the EBUS-TBNA group were diagnosed (<i>p</i> = 0.016). The percentages of intraoperative mild to moderate bleeding complications were 23.9% (16/67) and 14.9% (10/67) in the EBUS-IFB-TLP and in the EBUS-TBNA groups, respectively (<i>p</i> = 0.109).</p><p><strong>Conclusion: </strong>This study demonstrated that EBUS-IFB-TLP could be a feasible and effective method in the diagnosis of patients with MLNE, presenting an analogous safety profile compared with EBUS-TBNA. Further studies are needed to verify the diagnostic performance of EBUS-IFB-TLP for MLNE.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241282217"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354342","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":"Evaluation of preoperative cardiopulmonary reserve and surgical risk of patients undergoing lung cancer resection.","authors":"Francesco Petrella, Andrea Cara, Enrico Mario Cassina, Paola Faverio, Giovanni Franco, Lidia Libretti, Emanuele Pirondini, Federico Raveglia, Maria Chiara Sibilia, Antonio Tuoro, Sara Vaquer, Fabrizio Luppi","doi":"10.1177/17534666241292488","DOIUrl":"10.1177/17534666241292488","url":null,"abstract":"<p><p>Lung cancer represents the second most frequent neoplasm and the leading cause of neoplastic death among both women and men, causing almost 25% of all cancer deaths. Patients undergoing lung resection-both for primary and secondary tumors-require careful preoperative cardiopulmonary functional evaluation to confirm the safety of the planned resection, to assess the maximum tolerable volume of resection or to exclude surgery, thus shifting the therapeutic approach toward less invasive options. Cardiopulmonary reserve, pulmonary lung function and mechanical respiratory function represent the cornerstones of preoperative assessment of patients undergoing major lung resection. Spirometry with carbon monoxide diffusing capacity, split function tests, exercise tests and cardiologic evaluation are the gold standard instruments to safely assess the entire cardiorespiratory function before pulmonary resection. Although pulmonary mechanical and parenchymal function, together with cardiorespiratory compliance represent the mainstay of preoperative evaluation in thoracic surgery, the variables that are responsible for fitness in patients who have undergone lung resection have expanded and are being continually investigated. Nevertheless, because of the shift to older patients who undergo lung resection, a global approach is required, taking into consideration variables like frailty status and likelihood of postoperative functional deterioration. Finally, the decision to go ahead with surgery in fragile patients being consideredfor lung resection should be evaluated in a multispecialty preoperative discussion to provide a personalized risk stratification. The aim of this review is to focus on preoperative evaluation of cardiopulmonary reserve and surgical risk stratification of patients candidate for lung cancer resection. It does so by a literature search of clinical guidelines, expert consensus statements, meta-analyses, clinical recommendations, book chapters and randomized trials (1980-2022).</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241292488"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508491","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":"Impact of lumacaftor/ivacaftor on the bacterial and fungal respiratory pathogens in cystic fibrosis: a prospective multicenter cohort study in Sweden.","authors":"Mahasin Al Shakirchi, Kimmo Sorjonen, Lena Hjelte, Lena Klingspor, Peter Bergman, Petrea Ericson, Marcus Svedberg, Ulrika Lindberg, Christine Hansen, Isabelle de Monestrol","doi":"10.1177/17534666241254090","DOIUrl":"10.1177/17534666241254090","url":null,"abstract":"<p><strong>Background: </strong>A significant decline in pulmonary exacerbation rates has been reported in CF patients homozygous for F508del treated with lumacaftor/ivacaftor. However, it is still unclear whether this reduction reflects a diminished microbiological burden.</p><p><strong>Objectives: </strong>The aim of this study was to determine the impact of lumacaftor/ivacaftor on the bacterial and fungal burden.</p><p><strong>Design: </strong>The study is a prospective multicenter cohort study including 132 CF patients homozygous for F508del treated with lumacaftor/ivacaftor.</p><p><strong>Methods: </strong>Clinical parameters as well as bacterial and fungal outcomes 1 year after initiation of lumacaftor/ivacaftor were compared to data from 2 years prior to initiation of the treatment. Changes in the slope of the outcomes before and after the onset of treatment were assessed.</p><p><strong>Results: </strong>Lung function measured as ppFEV1 (<i>p</i> < 0.001), body mass index (BMI) in adults (<i>p</i> < 0.001), and BMI <i>z</i>-score in children (<i>p</i> = 0.007) were improved after initiation of lumacaftor/ivacaftor. In addition, the slope of the prevalence of <i>Streptococcus pneumoniae</i> (<i>p</i> = 0.007) and <i>Stenotrophomonas maltophilia</i> (<i>p</i> < 0.001) shifted from positive to negative, that is, became less prevalent, 1 year after treatment, while the slope for <i>Candida albicans</i> (<i>p</i> = 0.009), <i>Penicillium</i> spp (<i>p</i> = 0.026), and <i>Scedosporium apiospermum</i> (<i>p</i> < 0.001) shifted from negative to positive.</p><p><strong>Conclusion: </strong>The current study showed a significant improvement in clinical parameters and a reduction of some of CF respiratory microorganisms 1 year after starting with lumacaftor/ivacaftor. However, no significant changes were observed for <i>Pseudomonas aeruginosa, Staphylococcus aureus</i>, or <i>Aspergillus fumigatus</i>, key pathogens in the CF context.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241254090"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11119492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082476","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}