Monaldi Archives for Chest Disease最新文献

{"title":"Comments on \"Predictive accuracy of lung and diaphragmatic ultrasound in weaning from mechanical ventilation: a comparison with the Rapid Shallow Breathing Index\".","authors":"Rita Pino, Francisco Salinas-Barahona, Ruvistay Gutiérrez-Arias","doi":"10.4081/monaldi.2026.4179","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4179","url":null,"abstract":"<p><p>Dear Editor, We read with interest the study by Shalini Bellan et al. on weaning outcomes in critically ill patients who underwent invasive mechanical ventilation for more than 24 hours...</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of flexible bronchoscopic retrieval of airway foreign bodies in adults.","authors":"Ashok Kuwal, Chaina Ram Choudhary, Bhoopendra Kumar Saini, Radheshyam Meghwal, Balveer Choudhary","doi":"10.4081/monaldi.2026.4251","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4251","url":null,"abstract":"<p><p>Unlike in children, foreign body aspiration in adults is an uncommon occurrence. The clinical presentation is often nonspecific, with a myriad of symptoms and radiological abnormalities. These cases can mimic chronic lung conditions like asthma and chronic obstructive pulmonary disease, thereby delaying definitive diagnosis and timely interventions. We conducted a retrospective analysis of the bronchoscopy suite database (January 2022 to December 2025) to identify cases subjected to flexible bronchoscopy for suspicion of a foreign body.  Data on demographics, clinical symptoms, radiological findings, type of foreign body, retrieval methods, and procedure-related complications were retrieved and analyzed. During the study period, a total of 1679 flexible bronchoscopies were performed. Of these, 12 (0.71%) were done for suspected foreign body aspiration. A foreign body was identified in 10 cases (83.33%), and in eight cases (80%), the foreign body was successfully retrieved using a flexible bronchoscope. The mean age of the study population was 48.38±20.23 years, with a female preponderance (62.5%). The most common radiological presentation was atelectasis, and direct visualization of foreign bodies was found in five cases (627.5%). Organic foreign bodies were commonly identified (87.5% of cases); among them, betel nut was the most common foreign body. Grasping forceps and Dormia baskets were the most commonly used instruments, with no major complications. Foreign body aspiration in adults is a rare clinical entity, and a high index of suspicion is required to identify such cases. Flexible bronchoscopy is the modality of choice for diagnosis and retrieval of foreign bodies with a high success rate and minimal complications.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABO blood group-dependent association of serum retinol-binding protein 4 with eosinophilic inflammation and spirometric parameters in adults with asthma.","authors":"Rasha Al-Darraji, Zahraa Abdulaali Al-Mudhafar","doi":"10.4081/monaldi.2026.4226","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4226","url":null,"abstract":"<p><p>Growing evidence links retinol binding protein-4 (RBP4) to inflammation; however, its association with inflammatory cell indices and spirometric parameters in asthma remains unclear, and the potential modifying role of ABO blood group has yet to be explored. The main aim was to assess the associations of serum RBP4 with inflammatory cell indices and spirometric parameters in adults with asthma stratified by blood group O and non-O. Adults with physician-diagnosed asthma attending a respiratory clinic between January and June 2026 were consecutively enrolled in this cross-sectional study. Spearman's correlation assessed associations involving inflammatory cell indices, whereas Pearson's correlation evaluated associations between normally distributed serum RBP4 and spirometric parameters. Of the 88 adults with asthma enrolled, 64 had available ABO blood group data (38 O and 26 Non-O) and were included in the blood group-stratified analyses. In the O group, RBP4 was positively correlated with eosinophil count (ρ=0.35, p=0.03), eosinophil-to-neutrophil ratio (ρ=0.42, p<0.01), and eosinophil-to-lymphocyte ratio (ρ=0.41, p=0.01), whereas no significant associations were observed in the non-O group. Serum RBP4 was not correlated with spirometric parameters in either group. The forced expiratory volume in one second/forced vital capacity ratio was inversely correlated with eosinophil and lymphocyte counts only in the O group, while lymphocyte count showed an inverse correlation with forced expiratory flow between 25% and 75% of forced vital capacity in the non-O group. In conclusion, serum RBP4 was positively associated with eosinophilic inflammatory markers only in adults with asthma belonging to blood group O, whereas no such associations were observed in the non-O group.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinventing vitamin K antagonist therapy management: an implementation study of a home-based integrated monitoring model.","authors":"Margherita Scapaticci, Sebastiano Nigro, Federica Caveduri, Rita Mancini, Andrea Bartolini","doi":"10.4081/monaldi.2026.4066","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4066","url":null,"abstract":"<p><p>Vitamin K antagonist (VKA) oral anticoagulant therapies are crucial for preventing thromboembolic complications in cardiovascular diseases; however, their narrow therapeutic range necessitates frequent monitoring of the International Normalized Ratio (INR), posing significant challenges for elderly and frail patients. This article presents the implementation of a new home-based monitoring model for VKA therapy that integrates digital tools with clinical supervision. Since 2022, the Local Health Authority of Bologna (Italy) has implemented a home-based coagulation diagnostics model to improve VKA management, consisting of an INR PoCT Network that integrates hospital and community services through a digital system that streamlines data collection and oversight. Portable devices, supervised by laboratory personnel, provide home-based results comparable to central laboratory standards, improving workflows and enabling timely clinical decisions. By 2024, the INR PoCT Network comprises 17 home care units serving 1,701 patients. Approximately 20,000 blood samples are processed each year, with further growth expected. Nurses perform INR testing using the Xprecia Prime™ analyzer (Universal Biosensors Inc.), and results undergo automated self-verification based on algorithms aligned with central laboratory procedures, ensuring accuracy and reliability. A digital report is generated to support timely therapy adjustments and follow-up. This model reduces Turn Around Time for coagulation results from more than three hours to about 20 minutes, improves monitoring effectiveness, decreases hospital visits, and enhances patients' quality of life. The system demonstrates that investing in home monitoring improves comfort, reduces healthcare burden, and modernizes VKA therapy management through a scalable, accurate, and patient-centered approach.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of psychosocial benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease patients.","authors":"Vipin Chandra, Ramakant Dixit, Manudev Mehta, Mukesh Goyal","doi":"10.4081/monaldi.2026.3912","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3912","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is associated with significant symptom burden, impaired quality of life, and psychosocial morbidity. Pulmonary rehabilitation (PR) is a recommended non-pharmacological intervention, but evidence focusing on its psychosocial benefits remains limited. The objective of this study was to assess the effect of hospital-based outpatient PR on psychosocial parameters and health-related quality of life in patients with COPD receiving standard pharmacotherapy. This before-after interventional study included 50 male patients with stable COPD who underwent a structured outpatient PR program for 24 weeks in addition to standard medical therapy. Assessments were performed at baseline, 12 weeks, and 24 weeks. Psychosocial outcomes were evaluated using the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the COPD Assessment Test (CAT) and the St. George's Respiratory Questionnaire-COPD-specific version (SGRQ-C). Statistical analysis was performed with significance set at p<0.05. PR led to significant improvements in psychosocial and quality-of-life outcomes. Mean HADS anxiety and depression scores showed significant reductions at 12 and 24 weeks compared to baseline (p<0.001). Quality-of-life scores improved significantly, with reductions in CAT and SGRQ-C scores at follow-up (p<0.001). A marked reduction in COPD exacerbations and hospital admissions was also observed during the study period. Hospital-based outpatient PR significantly improves psychosocial well-being and health-related quality of life while reducing morbidity in patients with COPD, supporting its routine integration into comprehensive COPD care.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate <i>versus </i>gradual noninvasive ventilatory pressure-or-duration step-down in chronic obstructive pulmonary disease patients: a randomized trial.","authors":"Montaser Gamal Ahmed, Samiaa Hamdy Sadek, Waleed Gamal Elddin Khaleel","doi":"10.4081/monaldi.2026.4092","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4092","url":null,"abstract":"<p><p>Despite the proven role of noninvasive ventilation (NIV) as an effective treatment for acute hypercapnic respiratory failure (AHRF) in patients with chronic obstructive pulmonary disease (COPD), no clear agreement has been reached regarding the ideal weaning strategy. This study aimed to compare three NIV weaning strategies in terms of efficiency and safety among COPD patients with AHRF. A total of 105 COPD patients stabilized on NIV were enrolled in this randomized clinical trial and equally distributed into three groups (n=35 each): duration step-down (group A), pressure step-down (group B), and immediate withdrawal (group C). The primary endpoint was successful weaning within 48 hours. Secondary outcomes included duration of NIV use, lengths of ICU and hospital stay, predictors of weaning failure, and complication rates. The results of this study indicated that successful weaning rates differed significantly among the groups, being highest in group A (82.9%), followed by group B (74.3%), and lowest in group C (54.3%) (p<0.01). Compared with other strategies, immediate withdrawal was associated with higher rates of weaning failure. Although NIV duration was significantly shorter in group C (p<0.001), complication rates and post-discharge outcomes were similar across the three groups. In this trial, gradual duration- and pressure-based step-down strategies were associated with higher rates of successful NIV weaning than immediate withdrawal, with the highest observed success rate in the duration-based step-down group.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of liver scoring systems in predicting early outcomes after pericardiectomy: a single-center retrospective study.","authors":"Mahmoud AlShiekh, Vijayakumar Muppiri, Ayman Helal, Samer Bazerbashi, Aviral Sethi, Udit Kathuria, Aladdin Bashir, Mohammed Allam, Malcolm Dalrymple-Hay","doi":"10.4081/monaldi.2026.3956","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3956","url":null,"abstract":"<p><p>Pericardiectomy for constrictive pericarditis remains a high-risk operation, and early outcomes are inadequately predicted by conventional cardiac risk models despite the high prevalence of chronic hepatic congestion in this population. We performed a retrospective observational analysis of 104 consecutive patients undergoing isolated pericardiectomy between 2010 and 2024 to determine whether established hepatic scoring systems [Child-Pugh, Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease-Sodium (MELD-Na)] predict early mortality and major postoperative morbidity. Preoperative clinical and biochemical variables were used to derive the hepatic scores. The primary endpoint was 30-day mortality; the secondary endpoint was new postoperative renal-replacement therapy. Thirty-day mortality was 4.8% (5/104). Patients were classified as Child-Pugh A in 66 (63.5%), B in 35 (33.7%), and C in 3 (2.9%), with corresponding mortalities of 1.5%, 2.9%, and 100% (p<0.01 for trend). Discrimination for 30-day mortality was strong for Child-Pugh [area under the receiver operating characteristic curve (AUC) 0.89, 95% confidence interval 0.73-1.00], MELD (0.85, 0.60-0.98), and MELD-Na (0.83, 0.55-0.97), whereas EuroSCORE II showed no meaningful predictive ability (AUC≈0.51). Hepatic dysfunction quantified by Child-Pugh and MELD-based scores is a strong predictor of early mortality after pericardiectomy and outperforms conventional cardiac risk models in this cohort. Incorporation of structured hepatic assessment into preoperative risk stratification may improve perioperative planning and patient counseling; however, the small number of Child-Pugh C patients and the retrospective single-center design necessitate validation in larger prospective cohorts.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractional exhaled nitric oxide in non-cystic fibrosis bronchiectasis: an exploratory prospective observational study.","authors":"Eugerta Dilka, Eva Duraku, Artan Simaku, Perlat Kapisyzi","doi":"10.4081/monaldi.2026.3873","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3873","url":null,"abstract":"<p><p>Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of type 2 airway inflammation, but its role in non-cystic fibrosis bronchiectasis remains uncertain. This study explored the associations of FeNO with peripheral blood eosinophils, pulmonary function, high-resolution computed tomography (HRCT)-defined morphology, and short-term post-treatment change in adults with non-cystic fibrosis bronchiectasis. We conducted an exploratory prospective observational study including 152 adults with clinically and HRCT-confirmed non-cystic fibrosis bronchiectasis admitted to a national tertiary pulmonary center. FeNO was measured using a standardized single-flow technique. Pulmonary function testing, blood eosinophil assessment, and HRCT evaluation were performed. Descriptive statistics, between-group comparisons, correlation analyses, and exploratory multivariable linear regression were used. A subgroup underwent repeat FeNO assessment after antibiotic treatment. Mean FeNO was 12.1±7.9 ppb. FeNO correlated positively with blood eosinophil percentage (r=0.41, p<0.001) and MEF50% predicted (r=0.48, p<0.001) and inversely with total lung capacity % predicted (r=-0.39, p<0.001). FeNO distributions differed across ventilatory patterns (overall Kruskal-Wallis p=0.030) and HRCT morphology groups (overall Kruskal-Wallis p=0.040); the exploratory cylindrical versus cystic/saccular comparison yielded p=0.023 (unadjusted). In exploratory multivariable regression, blood eosinophil percentage remained associated with FeNO (β=1.12, 95% confidence interval: 0.29-1.95; p=0.009). Among 55 reassessed patients, FeNO decreased from 12.1±6.8 to 7.0±3.1 ppb after antibiotic treatment (p=0.010). FeNO was generally low in adults with non-cystic fibrosis bronchiectasis but showed exploratory associations with eosinophilic inflammation, selected pulmonary function parameters, HRCT morphology, and short-term post-treatment change. Larger longitudinal studies with standardized severity classification, microbiological characterization, and predefined outcomes are needed before FeNO can be recommended for routine clinical use.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The determinants of incorrect inhaler use in patients with obstructive airway disease.","authors":"Aditi Gupta, Komaldeep Kaur, Abhishek Gupta","doi":"10.4081/monaldi.2026.4305","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4305","url":null,"abstract":"<p><p>Inhaler therapy is the standard treatment for obstructive airway disease. Even in today's world, it is very challenging to utilize this therapy optimally. Errors in inhaler technique are very common. Identifying the errors is the first step towards correction to improve the disease. This is a cross-sectional observational study conducted at AIMS, Mohali, where 212 patients on inhaler therapy were enrolled who were diagnosed with asthma or chronic obstructive pulmonary disease or post-tuberculosis lung disease. The inhaler technique was assessed by a 5-point inhaler technique checklist by the clinician during the OPD visit. A multivariate binomial regression analysis was performed to calculate the crude and adjusted odds ratio of at least 1 error in inhalation technique and other covariates, including age, gender, education, profession, device, duration, and diagnosis. Among 212 enrolled patients, 135 adults (18-60 yrs) and 77 elderly (>60 years) were analyzed. Elderly [p<0.001; adjusted odds ratio (AOR) 8.12], unemployed (p=0.016), more than 5 years of inhaler use (p=0.005; AOR 9.54) and metered dose inhaler (p<0.001; AOR 5.86) had more chances of committing at least 1 error in inhaler technique. Identifying and correcting the errors in inhalational technique is the easiest and cost effective method to decrease the exacerbations and improve disease control in patients suffering from OAD by further decreasing the healthcare burden.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic blind spot of spirometric staging in biomass-related non-smoking chronic obstructive pulmonary disease: a cross-sectional study of spirometry-diffusion discordance in a rural South Indian population.","authors":"Chittin N Swamy, Sandeepa H S, Deepu C C, Chirag K C, Nandakishore Bommeri","doi":"10.4081/monaldi.2026.4174","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4174","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is heterogeneous, yet severity is conventionally graded by spirometry [forced expiratory volume in 1 second (FEV1)] on the assumption that airflow limitation reflects parenchymal damage. Biomass-related non-smoking COPD (NS-COPD) is common in low- and middle-income countries. In this hospital-based cross-sectional study, we compared the physiological phenotypes of smoking COPD (S-COPD) and biomass-related NS-COPD and tested the concordance between Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric severity and diffusion-based gas-exchange impairment. A total of 91 stable COPD patients (S-COPD, n=54; NS-COPD, n=37) underwent post-bronchodilator spirometry, single-breath diffusing capacity of the lung for carbon monoxide (DLCO) with transfer coefficient (KCO), residual volume to total lung capacity ratio, and the 6-minute walk test; cohorts were stratified by exposure (>10 pack-years vs. >60 hour-years of biomass) and compared using the Student t-test and Fisher's exact test. Compared with smokers, non-smokers had higher DLCO (71.4±12.4 vs. 57.7±17.5% predicted; p<0.001) and KCO (0.95±0.19 vs. 0.71±0.22 mmol/min/kPa/L; p<0.001). All non-smokers with severe (GOLD 3) airflow limitation (8/8, 100%) retained normal or only mildly impaired diffusion [7/8 (87.5%) strictly normal], whereas 14/28 (50.0%) GOLD 3 smokers had impaired gas exchange [4/28 (14.3%) severe]. Non-smokers more often retained a normal DLCO [31/37 (83.8%) vs. 26/54 (48.1%); odds ratio 5.6, 95% confidence interval 2.0-15.5; p<0.001]. This difference persisted after multivariable adjustment for age, sex and body mass index (odds ratio 30.0, 95% confidence interval 2.5-358.5; p=0.007) and after further adjustment for FEV1 percent predicted (odds ratio 21.1, 95% confidence interval 1.6-282.7; p=0.021), indicating that the dissociation was not explained by these covariates or by the degree of airflow limitation itself. GOLD staging tended to overestimate parenchymal severity in biomass-related NS-COPD, in which airflow obstruction was largely uncoupled from gas-exchange loss, whereas in smokers the two were more tightly coupled. These cross-sectional, single-center findings, limited by a sex imbalance and the absence of imaging confirmation, support routine DLCO/KCO measurement to phenotype these patients and, where imaging is scarce, as a low-cost structural surrogate.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}