Lancet Respiratory Medicine最新文献

{"title":"Global epidemiology and burden of interstitial lung disease","authors":"Paolo Spagnolo, Sabina A Guler, Nazia Chaudhuri, Zarir Udwadia, Lucile Sesé, Bhavika Kaul, Juan I Enghelmayer, Claudia Valenzuela, Atul Malhotra, Christopher J Ryerson, Yet H Khor, Tamera J Corte, Vincent Cottin","doi":"10.1016/s2213-2600(25)00129-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00129-8","url":null,"abstract":"The global incidence and prevalence of interstitial lung disease (ILD) are difficult to determine due to the rarity of the condition, inconsistent case ascertainment and reporting methods, and differences in risk factors, burden of exposures, and access to health-care systems across geographical areas. With these caveats, several studies have reported an increased incidence and prevalence of ILD over time. Idiopathic pulmonary fibrosis is the most common and extensively studied ILD, whereas connective tissue disease-associated ILD and hypersensitivity pneumonitis display the most geographical variability. Except for idiopathic pulmonary fibrosis, connective tissue disease-associated ILD, hypersensitivity pneumonitis, and sarcoidosis, few data are available for other ILDs. Access to health care remains uneven particularly in low-income and middle-income countries, leading to major health disparities. Socioeconomic inequalities also affect morbidity and mortality within and across countries. We performed a non-systematic review of the most recent literature on the epidemiology and burden of ILD, and highlighted areas where substantial gaps in knowledge remain and further studies are needed. The introduction of new tools, including nationwide health-care databases and monitoring of air pollution exposure, is opening new avenues for ILD epidemiology research; however, we are only at the beginning of understanding how the interaction between genetic and environmental factors contributes to the rising burden of these deadly diseases.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"24 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma: epidemiology, risk factors, and opportunities for prevention and treatment","authors":"Shamanthi M Jayasooriya, Graham Devereux, Joan B Soriano, Nishtha Singh, Refiloe Masekela, Kevin Mortimer, Peter Burney","doi":"10.1016/s2213-2600(24)00383-7","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00383-7","url":null,"abstract":"Asthma is characterised by variable airflow obstruction and is associated with symptoms of cough, wheeze, and dyspnoea, and with airway inflammation and hyperresponsiveness. There are approximately 300 million people with asthma worldwide. Despite a current plateau, the burden of this disease is likely to increase due to population growth, urbanisation, and ageing. Disease onset is associated with low birthweight, preterm birth, viral infections, in-utero passive smoke exposure, urbanisation, and occupational exposures. Obesity is associated with increased incidence and severity of asthma, whereas exposure to small allergen particles leads to severe disease. In adults and adolescents, inhaled corticosteroids in combination with formoterol (as anti-inflammatory reliever or as maintenance and anti-inflammatory reliever therapy) are widely recommended to control the symptoms of asthma. For children, low-dose inhaled corticosteroid is the preferred first-line treatment. Monotherapy with short-acting β-agonists is strongly discouraged. The WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases includes availability of affordable combination inhalers for asthma. Co-ordinated national asthma policies, ensuring access to inhalers, have resulted in fewer hospitalisations and school and work absences. Future asthma prevalence could be reduced by good maternal and infant care, with reduction in premature births and reduction in infant respiratory infections, and by reduction in obesity at all ages.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"94 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedaquiline, delamanid, linezolid, and clofazimine for rifampicin-resistant and fluoroquinolone-resistant tuberculosis (endTB-Q): an open-label, multicentre, stratified, non-inferiority, randomised, controlled, phase 3 trial","authors":"Lorenzo Guglielmetti, Uzma Khan, Gustavo E Velásquez, Maelenn Gouillou, Muhammad Hammad Ali, Samreen Amjad, Farees Kamal, Amanzhan Abubakirov, Elisa Ardizzoni, Elisabeth Baudin, Sagit Bektassov, Catherine Berry, Maryline Bonnet, Vijay Chavan, Sylvine Coutisson, Zhanna Dakenova, Bouke Catherine de Jong, Luong Van Dinh, Gabriella Ferlazzo, Ohanna Kirakosyan, Pearl Sun","doi":"10.1016/s2213-2600(25)00194-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00194-8","url":null,"abstract":"<h3>Background</h3>Pre-extensively drug-resistant (pre-XDR) tuberculosis (ie, multidrug-resistant or rifampicin-resistant with additional resistance to any fluoroquinolone) is difficult to treat. endTB-Q aimed to evaluate the efficacy and safety of bedaquiline, delamanid, linezolid, and clofazimine (BDLC) compared with the standard of care for patients with pre-XDR tuberculosis.<h3>Methods</h3>This open-label, multicentre, stratified, non-inferiority, randomised, controlled, phase 3 trial was conducted in ten hospitals in India, Kazakhstan, Lesotho, Pakistan, Peru, and Viet Nam. Participants aged 15 years or older who had pulmonary tuberculosis with resistance to rifampicin and fluoroquinolones were included. Participants were randomly assigned (2:1) to the BDLC group (all-oral bedaquiline 400 mg once per day for 2 weeks followed by 200 mg three times per week, delamanid 100 mg twice per day, linezolid 600 mg once per day for 16 weeks and then either 300 mg once per day or 600 mg three times per week, and clofazimine 100 mg once per day) or the control group (individualised WHO-recommended longer standard of care). Randomisation was stratified by country and baseline disease extent. BDLC was administered for 39 weeks (9-month regimen) for extensive disease and 24 weeks (6-month regimen) for limited disease and extended to 9 months for those with a positive culture at 8 weeks or later or a missing 8-week culture result. Site staff and participants were not masked, whereas investigators and laboratory staff were masked to treatment assignment. The primary endpoint was favourable outcome (two consecutive, negative cultures including one between weeks 65 and 73; or favourable bacteriological, radiological, and clinical evolution) at week 73 after randomisation in the modified intention-to-treat (mITT) and per-protocol populations. We report the risk differences adjusted for stratification variables, with a non-inferiority margin of –12%. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT03896685</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>.<h3>Findings</h3>Between April 4, 2020, and March 28, 2023, 1030 individuals were screened and 324 (31%) were randomly assigned (219 to the BDLC group and 105 to the control group). 114 (46%) participants were female and 133 (54%) were male. Median age was 30·5 years (IQR 21·6–43·0). 157 (64%) participants had extensive disease at baseline. In the BDLC group, 47 (29%) of 163 were assigned to receive the 6-month regimen and 116 (71%) the 9-month regimen. The core regimen of BDLC plus one or more other drugs was used f","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"5 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"endTB-Q results in the face of rising bedaquiline resistance","authors":"Norbert Heinrich, Norbert Ndjeka, Celso Khosa, Pauline Howell, Katharina Kranzer, Debra Vambe, Sean Wasserman, Michael Hoelscher","doi":"10.1016/s2213-2600(25)00246-2","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00246-2","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"676 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled isoflurane for sedation of mechanically ventilated children in intensive care (IsoCOMFORT): a multicentre, randomised, active-control, assessor-masked, non-inferiority phase 3 trial","authors":"Jordi Miatello, Alba Palacios-Cuesta, Peter Radell, André Oberthuer, Stephen Playfor, Irene Amores-Hernández, Simon Barreault, Richard Biedermann, Maria Teresa Charlo Molina, Juan Encarnación Martínez, Benjamin Kuehne, Santiago Mencía, Maria Dolores Méndez, Christoph Menzel, Luc Morin, Lidia Oviedo, Jean-Eudes Piloquet, Magnus Falkenhav, Peter Sackey, Uwe Trieschmann, Padmanabhan Ramnarayan","doi":"10.1016/s2213-2600(25)00203-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00203-6","url":null,"abstract":"<h3>Background</h3>Inhaled sedation for mechanical ventilation in patients who are critically ill is emerging as an alternative sedative strategy; however, data are scarce on its efficacy and safety in children, compared with intravenous sedation. The IsoCOMFORT trial aimed to compare the efficacy of inhaled sedation with isoflurane versus intravenous midazolam in the paediatric setting.<h3>Methods</h3>IsoCOMFORT was a randomised, active-control, assessor-masked, non-inferiority phase 3 trial conducted across 19 paediatric intensive care units in Spain, France, Germany, and the UK. Children aged 3–17 years who were critically ill and required invasive mechanical ventilation and sedation for an expected duration of at least 12 h were randomly assigned (2:1) via an interactive web-response system to inhaled sedation with isoflurane or to intravenous sedation with midazolam. Randomisation was done in permuted blocks (sizes 3 and 6), stratified by age group, reason for intensive care unit admission (planned or unplanned mechanical ventilation), and country, with treatment allocation masked to outcome assessors. At baseline, a target range for sedation depth was prescribed based on the COMFORT Behaviour (COMFORT-B) scale, and sedation dosing was titrated to reach the target range. Sedative treatment was planned for up to 48 h (±6 h). The primary endpoint was the percentage of time that an adequate sedation depth was maintained, in the absence of rescue sedation, within the individually prescribed target range, as monitored every 2 h for an expected minimum of 12 h (up to 48±6 h) with the COMFORT-B scale. The primary endpoint was assessed for non-inferiority (margin –9·36 percentage points) in the full analysis set (all randomly assigned participants who received ≥6 h of the allocated study sedative and ≥3 masked COMFORT-B assessments), according to intention to treat. Safety was assessed in all participants who received study treatment. The trial was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT04684238</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and EudraCT, 2020-000578-31, and is completed.<h3>Findings</h3>Between Jan 14, 2021, and Jan 19, 2023, 96 children were randomly assigned: 63 to the isoflurane group and 33 to the midazolam group. 92 participants were included in the full analysis set (mean age 7·7 years [SD 4·1]; 35 [38%] female and 57 [62%] male). The least-squares mean percentage of time in the COMFORT-B target range was 68·94% (95% CI 52·83–85·05) in the isoflurane group and 62·37% (44·70–80·04) in the midazolam group. The least-squares mean diffe","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"52 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicted bodyweight—a misleading metric for tidal volume titration?","authors":"Marcus J Schultz, Pien Swart, Patricia R M Rocco","doi":"10.1016/s2213-2600(25)00134-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00134-1","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"37 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isoflurane instead of midazolam: is it really first-line?","authors":"Maria Cristina Mondardini, Angela Amigoni","doi":"10.1016/s2213-2600(25)00245-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00245-0","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"153 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the generalisability of formulas used to set tidal volumes in mechanically ventilated patients: an observational, multicohort, retrospective study","authors":"Aartik Sarma, Kathryn M Sullivan, Aaron D Baugh, Nirav R Bhakta, Carolyn S Calfee","doi":"10.1016/s2213-2600(25)00126-2","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00126-2","url":null,"abstract":"<h3>Background</h3>Lung-protective mechanical ventilation with low tidal volume (V_T) decreased mortality in the ARMA trial. V_T in that trial was adjusted to predicted bodyweight (PBW) as a proxy for preinjury lung volumes, an approach that is now commonly used to set target V_T in patients who are mechanically ventilated. In other clinical contexts, PBW is not used to estimate lung volumes and spirometric reference equations are used instead. We aimed to compare predicted forced vital capacity (PFVC), calculated using the Global Lung Initiative 2012 spirometric reference equations, with PBW as a proxy for preinjury lung volume.<h3>Methods</h3>In this observational, multicohort, retrospective study we compared ARMA PBW with PFVC estimated with the Global Lung Initiative 2012 reference equations for two cohorts: Medical Information Mart for Intensive Care-IV (MIMIC-IV), a cohort of patients from a single academic medical centre in Boston, MA, USA, and electronic Intensive Care Unit Collaborative Research Database (eICU-CRD), a cohort of patients from 208 hospitals in the USA. Patients who had lung-protective ventilation, hypoxaemia, and height in the range 150–210 cm were included. The data were collected from publicly available, deidentified datasets. We then studied the association between normalised V_T (V_T per PBW or V_T per PFVC) and the ratio of lung volume estimates (PBW:PFVC) and mortality, driving pressure, and normalised elastance in patients receiving lung-protective ventilation with V_T per PBW of 6–8 mL/kg.<h3>Findings</h3>9152 patients were included from MIMIC-IV (3064 [33·5%] female and 6088 [66·5%] male; 645 [7·0%] Black, 5885 [64·3%] White, and 2622 [28·6%] other race; mean age 63 years [SD 16]) and 12 420 patients were included from eICU-CRD (4262 [34·3%] female and 8158 [65·7%] male; 1023 [8·2%] Black, 10 093 [81·3%] White, and 1304 [10·5%] other race; mean age 62 years [SD 16]). Patients who were younger, male, and White had greater PFVCs than patients who were older, female, and non-White with the same PBW. A 1 SD increase in PBW:PFVC ratio was associated with 1·43-fold (95% CI 1·17–1·76) higher odds of death in MIMIC-IV and similar results were observed in the eICU-CRD cohort.<h3>Interpretation</h3>Adjusting V_T using PBW formulas leads to overestimation of preinjury tidal lung volumes in patients who are older, shorter, female, and non-White compared with other patients. This algorithmic bias could contribute to mortality disparities in patients who are ventilated. Further research is required to establish the optimal tidal volumes for patients who are mechanically ventilated.<h3>Funding</h3>National Heart, Lung, and Blood Institute.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"10 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial lung abnormalities: challenges and opportunity","authors":"Yuben Moodley","doi":"10.1016/s2213-2600(25)00214-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00214-0","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"279 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC): a multicentre, double-blind, randomised controlled trial","authors":"Virginie Lemiale, Matthieu Resche-Rigon, Yoann Zerbib, Djamel Mokart, Nicolas De Prost, Florent Wallet, Pierre Perez, Achille Kouatchet, Laurent Argaud, Maxens Decavèle, édéric Pène, Amelie Seguin, Bruno Megarbane, Laure Calvet, Muriel Picard, Guillaume Rigault, Eric Mariotte, Lila Bouadma, Igor Theodose, Fabienne Tamion, Elie Azoulay","doi":"10.1016/s2213-2600(25)00125-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00125-0","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;&lt;em&gt;Pneumocystis jirovecii&lt;/em&gt; pneumonia in HIV-negative immunocompromised patients has a hospital mortality rate of 30–50%. Adjunctive corticosteroids improve outcomes of &lt;em&gt;P jirovecii&lt;/em&gt; pneumonia in HIV-positive patients. The aim of this trial was to assess the effects of early adjunctive corticosteroid therapy for 21 days in HIV-negative patients with &lt;em&gt;P jirovecii&lt;/em&gt; pneumonia responsible for acute hypoxaemia respiratory failure.&lt;h3&gt;Methods&lt;/h3&gt;This multicentre, double-blind, randomised controlled trial was conducted at 27 hospitals in France. We included patients with acute respiratory failure, aged 18 years or older with mild-to-severe hypoxaemia, microbiological documentation of &lt;em&gt;P jirovecii&lt;/em&gt; pneumonia, and anti-&lt;em&gt;Pneumocystis&lt;/em&gt; treatment duration of less than 7 days. Patients were randomly assigned (1:1) to the corticosteroid group (adjunctive corticosteroid therapy of methylprednisolone intravenously, 30 mg twice per day from days 1 to 5, 30 mg once per day from days 6 to 10, and 20 mg once per day until day 21) or placebo group (2 mL or 3 mL syringes of isotonic saline intravenously) using a web-based system. Permutation blocks of fixed size unknown to the local investigators were used. Stratification factors were centre, long-term corticosteroid treatment started more than 1 month before enrolling in the trial, underlying disease (malignancy &lt;em&gt;vs&lt;/em&gt; other), and oxygen needs at randomisation (&lt;6 &lt;em&gt;vs&lt;/em&gt; ≥6 L per min). The primary outcome was all-cause 28-day mortality defined as the proportion of patients who died within 28 days, analysed in the intention-to-treat (ITT) population. This trial was registered on &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;NCT02944045&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; (closed).&lt;h3&gt;Findings&lt;/h3&gt;From Feb 23, 2017, to Feb 23, 2024, 466 patients with acute respiratory failure were assessed for eligibility. Of those, 240 were excluded and 226 patients were randomly assigned (114 assigned to the placebo group and 112 assigned to the corticosteroid group). The ITT population included 111 patients in the placebo group and 107 in the corticosteroid group. Median age was 67 years (IQR 59–73). 126 (58%) patients were male and 92 (42%) were female. Nearly all patients (208 [95%]) were in the ICU or intermediate care at randomisation. The median time from &lt;em&gt;P jirovecii&lt;/em&gt; pneumonia diagnosis to corticosteroid therapy initiation was 3 days (IQR 2–5). Patients received trial treatment for 13 days (range 7–20). All-cause 28-day mortality occurred in 36 (32·4%) patients in the placebo ","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"4 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}