Monaldi Archives for Chest Disease最新文献

{"title":"Variable expiratory airflow, and not airway obstruction, is the defining physiological feature of asthma.","authors":"Sunil K Chhabra","doi":"10.4081/monaldi.2026.3788","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3788","url":null,"abstract":"<p><p>Asthma is usually diagnosed by history and presence of airway obstruction with a significant bronchodilator response on spirometry. However, airway obstruction may not always be present, or a bronchodilator response may not be significant. Contrary to wide perception, airway obstruction is not the defining functional feature of asthma. Definitions of asthma have never included the term 'airways obstruction'. According to the Global Initiative for Asthma, the diagnosis of asthma requires a history of typical variable symptoms and confirmation by variable expiratory airflow. It has emphasized that variable expiratory airflow is the key physiological feature of asthma. Airway obstruction is a manifestation of this variability and represents one end of the spectrum of this variation. When airways obstruction is observed, a positive bronchodilator response is the most convenient method to confirm the diagnosis. However, when airway obstruction or bronchodilator responsiveness is not demonstrable, there are other options to demonstrate variability in not demonstrable, there are other options to demonstrate variability of expiratory airflows and confirm the diagnosis.</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":"149185730","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":"Inflammatory biomarkers associated with surgical intervention in pediatric pneumococcal pneumonia: a five-year retrospective cohort study.","authors":"Kostadin Ketev, Daniela Milanova-Ilieva, Ivanka Karavelikova, Zdravko Ivanov, Rosen Iliev, Penka Stefanova, Miroslava Bosheva","doi":"10.4081/monaldi.2026.3885","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3885","url":null,"abstract":"<p><p>Streptococcus pneumoniae remains an important cause of community-acquired pneumonia (CAP) in children, with complicated cases sometimes requiring surgical intervention. This 5-year retrospective cohort study included 104 children aged 1 month to 18 years hospitalized with microbiologically confirmed pneumococcal pneumonia at a tertiary referral center. We evaluated clinical and laboratory factors associated with surgical intervention, with particular emphasis on the C-reactive protein-to-albumin ratio (CAR) and fibrinogen-to-albumin ratio (FAR). Complications occurred in 72.1% of patients, and 45.2% required surgical intervention. Children requiring surgery were younger, had a longer duration of symptoms before hospitalization, and showed greater alterations in inflammatory biomarkers. In multivariable analysis, CAR [adjusted odds ratio (aOR) 1.29 per unit increase; 95% confidence interval (CI) 1.12-1.52; p=0.001] and FAR (aOR 1.14 per unit increase; 95% CI 1.03-1.28; p=0.021) remained independently associated with surgical intervention in separate adjusted models. Receiver operating characteristic curve analysis showed moderate discriminatory ability for CAR [area under the curve (AUC) 0.714; 95% CI 0.615-0.813] and FAR (AUC 0.701; 95% CI 0.580-0.822), while serum albumin showed the highest overall AUC (0.783; 95% CI 0.695-0.871). FAR demonstrated significantly greater discrimination than fibrinogen alone (p=0.005), whereas CAR did not significantly outperform CRP or albumin. These findings suggest that CAR and FAR may provide complementary information for identifying children at increased risk of surgical intervention. However, their clinical utility should be interpreted alongside clinical and radiological findings and requires prospective multicenter validation.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139128","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":"Clinical profile of pulmonary involvement in rheumatological disorders: a cross-sectional study in a rheumatology-associated lung disease clinic.","authors":"Indu Mb, Desh Deepak, Brijesh Sharma, Saloni Narang, Sumit Kumar Suman, Ajay Bhatta, Gunjan Lalwani, Vardhini Somayya, Nitin Kumar, Mala Chhabra, Nandini Duggal","doi":"10.4081/monaldi.2026.4080","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4080","url":null,"abstract":"<p><p>Rheumatological diseases (RDs) are characterized by autoimmune-mediated organ damage, with the lungs being an important target organ. Almost all compartments of the pulmonary system may be involved, with considerable heterogeneity in the frequency, severity, and spectrum of pulmonary manifestations. This heterogeneity may result in delayed diagnosis and treatment, leading to adverse outcomes. The objective of this study was to characterize the clinical, demographic, serological, and radiological features of pulmonary manifestations across a spectrum of rheumatic diseases. This cross-sectional study was conducted between 2016 and 2023 at a tertiary care center in New Delhi, India. Patients aged ≥18 years with a diagnosed or suspected RD and pulmonary manifestations were included. Patients who did not fulfill the American College of Rheumatology/European League against Rheumatism classification criteria for RD or the American Thoracic Society/European respiratory Society criteria for interstitial pneumonia with autoimmune features (IPAF), as well as those with chronic hypersensitivity pneumonitis or sequelae of previous pulmonary infections, were excluded. Of the 783 patients screened, 170 were diagnosed with rheumatology-associated lung disease (RALD) or IPAF. The mean age was 44.3 years, with a marked female predominance (85%). Rheumatoid arthritis (RA) and systemic sclerosis (SSc) accounted for 70% of cases, followed by IPAF, overlap syndromes, Sjögren syndrome (SjS), systemic lupus erythematosus (SLE), and idiopathic inflammatory myositis. Twenty-six patients with idiopathic interstitial pneumonia were reclassified as having IPAF, one of whom subsequently progressed to RA. Pulmonary symptoms preceded the diagnosis of RD in 13.6% of patients, occurred concurrently with the diagnosis in 17%, and developed during the course of RD in 69.4%. Antinuclear antibodies and rheumatoid factor were the most commonly detected autoantibodies, while anti-aminoacyl-tRNA synthetase antibodies were identified in 11 patients. RA demonstrated the broadest spectrum of pulmonary manifestations. Interstitial lung disease was the predominant pulmonary manifestation across all RDs except SLE. Non-specific interstitial pneumonia and usual interstitial pneumonia patterns accounted for 87% of cases. Other pulmonary manifestations included infections in RA and SLE; vascular and pleural involvement in RA, SSc, and SLE; and airway involvement in RA and SjS. Pulmonary manifestations may precede, coincide with, or develop after the onset of systemic features in RDs. Comprehensive pulmonary evaluation and collaborative care involving rheumatologists and pulmonologists may facilitate earlier diagnosis and optimize the management of RALDs.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139123","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":"Prevalence and patterns of inhalational exposures in patients with interstitial lung diseases: a cross-sectional study.","authors":"Tharini Ravichandran, Divya Saxena, Chitra Veluthat, Uma Devaraj, Priya Ramachandran, Uma Maheswari Krishnaswamy, Kavitha Venkatnarayan","doi":"10.4081/monaldi.2026.4008","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4008","url":null,"abstract":"<p><p>Given the etiologic importance of inhalational exposures in specific interstitial lung disease (ILD) subtypes like hypersensitivity pneumonitis (HP) and pneumoconiosis, this study systematically evaluates exposure patterns across all ILD subtypes and assesses the utility of a standardized questionnaire for improved exposure identification.  In this cross-sectional study, ILD patients were recruited between July 2023 and March 2024. Demographic, clinical, pulmonary function, radiological, and immunological parameters were recorded, and ILD subtypes were assigned by multidisciplinary discussion. Inhalational exposures were evaluated using a standardized questionnaire through in-person or telephonic interviews. Out of 139 total ILD patients, 107 (77%) reported at least one inhalational exposure, and 67 (48.2%) reported multiple exposures. These exposures were prevalent across multiple ILD subtypes beyond HP. Biomass (39.6%) and hay/grain (25.9%) were the most common. Blue-collar occupations were linked with higher odds of having any (81.8%) and multiple exposures (55.6%). Significant associations with HP were observed for animal hair and avian exposures, while tobacco smoke was associated with idiopathic pulmonary fibrosis. Having multiple exposures was associated with a significant reduction in forced vital capacity % predicted. Use of the standardized exposure questionnaire revealed more exposures per patient vs. routine history [median 1 (interquartile range 1-3) vs. 0 (interquartile range 0-1)], with 77% of participants classified as exposed vs. 41.7% by routine history (p<0.001).  Inhalational exposures are widely prevalent across ILD subtypes, including those not classically exposure-related, and standardized exposure assessment using questionnaires improves their detection.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129399","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":"Appropriateness/inappropriateness of access to an in-hospital rehabilitation program for patients with respiratory disease.","authors":"Sabrina Fenaroli, Mara Paneroni, Mauro Maniscalco, Antonio Spanevello, Mauro Carone, Giuseppina Cassetti, Cinzia Lastoria, Rodolfo Murgia, Michele Vitacca","doi":"10.4081/monaldi.2026.4012","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4012","url":null,"abstract":"<p><p>There are no descriptions of the \"ideal candidate\" or validated indices to justify admitting respiratory patients to hospital-based rehabilitation. This study aimed to quantify appropriate/inappropriate admissions to in-hospital rehabilitation programs among respiratory patients. We analyzed hospitalization records from the ICS Maugeri repository (01 January 2015 - 31 December 2024) across seven Italian ICS Maugeri centers. Patients were categorized as chronic respiratory failure (CRF; 45.70%), chronic obstructive pulmonary disease (COPD; 22.76%), asthma (0.07%), obstructive sleep apnea (OSAS; 10.89%), and miscellaneous dyspnea not related to COPD (19.84%). Anthropometric, Cumulative Illness Rating Scale, Medical Research Council (MRC) scale, Barthel dyspnea, COPD Assessment Test (CAT), 6-minute walk test (6MWT), and Short Physical Performance Battery (SPPB) were collected. Appropriateness of hospital admission was defined according to literature-based severity cut-offs for all disability items, while inappropriateness was computed on four contemporary items (excluding MRC). The cohort was predominantly male, aged 60-70 years, with CRF (46%) and multiple comorbidities; most (84%) were admitted from home, while >95% of patients returned home. High overall appropriateness in the whole group was 73-87% across items, with the highest % for 6MWT predicted across all TPs (74% OSAS-94% CRF) and lower for SPPB (60% OSAS-78% CRF) and for the MRC dyspnea score (75% OSAS-89% CRF). The CRF group demonstrated very high appropriateness (>78% in all items), COPD presented strong appropriateness for deconditioning (6MWT: 83%) dyspnea (MRC: 84%), asthma patients showed a lower CAT appropriateness (64%). The OSAS subgroup had the lowest entry appropriateness (55-74%). The dyspnea group exhibited high appropriateness for deconditioning (6MWT: 83%) and for dyspnea (MRC: 81%, Barthel dyspnea: 81%). Among 6086 complete cases, only 2.8% were deemed to be inappropriate admissions. The highest inappropriateness was in the dyspnea subgroup (6%), while the lowest was for CRF (0.7%).  Entry appropriateness was high or very high for overall items, showing 6MWT the best rate and CAT and SPPB the worst. CRF patients showed the highest appropriateness, while the rate of inappropriateness was overall low, with dyspnea and OSAS subgroups the worst and CRF the best. Future strategies must focus on developing standardized, multifaceted evaluation tools to objectively guide inpatient rehabilitation referrals.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129272","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":"Association of the -2549 insertion/deletion polymorphism in the promoter region of vascular endothelial growth factor towards chronic obstructive pulmonary disease susceptibility and clinical factors in the North Indian population.","authors":"Armandeep Kaur, Heena Kansal, Vishal Chopra, Kranti Garg, Siddharth Sharma","doi":"10.4081/monaldi.2026.3638","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3638","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent inflammation, airway remodeling, and irreversible airflow limitation. Vascular endothelial growth factor (VEGF) plays a critical role in angiogenesis and exerts antiapoptotic effects on endothelial cells. The -2549 insertion/deletion (I/D) polymorphism in the promoter region of the VEGF gene has been reported to modulate gene expression and may influence disease susceptibility. This case-control study aimed to investigate the association between the VEGF -2549 I/D polymorphism and susceptibility to COPD, including its relationship with clinical parameters. A total of 100 COPD patients and 100 age- and sex-matched healthy controls were genotyped for the VEGF -2549 I/D variant using polymerase chain reaction following DNA extraction from peripheral blood samples. Chi-square tests were employed to assess allelic and genotypic frequencies, while logistic regression was used to analyze associations with demographic and clinical factors. The DD genotype was more prevalent among COPD patients, and differences were observed in lung function (FEV₁), COPD Assessment Test scores, and Global Initiative for Chronic Obstructive Lung Disease classification; however, these associations were not statistically significant after adjustment for confounders. Subgroup analysis showed variations in genotype associations among male subjects and smokers, although these findings were not statistically significant. Overall, these findings do not demonstrate a significant association between the VEGF -2549 I/D polymorphism and COPD susceptibility. The observed subgroup and clinical patterns may warrant further investigation in larger studies, particularly in genetically diverse populations.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129429","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":"Outcomes of pulmonary rehabilitation in post-tuberculosis sequelae: a comparative analysis of home-based and hospital-based programs.","authors":"Manudev Mehta, Ramakant Dixit, Siddarth Mathur, Mukesh Goyal","doi":"10.4081/monaldi.2026.3900","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3900","url":null,"abstract":"<p><p>Post-tuberculosis lung disease (PTLD) is associated with persistent respiratory symptoms, reduced exercise capacity, impaired quality of life, and psychological morbidity despite successful completion of anti-tubercular therapy. Although pulmonary rehabilitation (PR) is an established therapeutic intervention, comparative evidence on home-based PR (HBPR) and hospital-based PR (HPR), particularly beyond 12 weeks, remains limited. So, to compare the effects of HBPR and HPR on clinical, functional, psychological, and pulmonary function outcomes in patients with PTLD, the study was done over a period of 24 weeks. This prospective comparative study included 50 patients with PTLD, of whom 30 underwent structured HBPR with weekly follow-up and 20 underwent supervised HPR. Allocation was based on feasibility and participant preference. Allocation was based on feasibility and participant preference. Participants were assessed at baseline, 12 weeks, and 24 weeks using the modified Medical Research Council (mMRC) dyspnea grade, body mass index (BMI), St. George's Respiratory Questionnaire (SGRQ), Depression Anxiety Stress Scale-21 (DASS-21), spirometry, and six-minute walk distance (6MWD). Changes within groups were analyzed for 0-12 weeks, 12-24 weeks, and 0-24 weeks, and change scores were compared between groups. Both rehabilitation strategies significantly improved dyspnea, nutritional status, quality of life, psychological well-being, pulmonary function, and exercise capacity over 24 weeks. In the HBPR group, mean 6MWD increased from 258.17±82.72 m to 377.00±82.38 m, while in the HPR group it increased from 308.00±118.84 m to 429.00±114.57 m (both p<0.001). Mean SGRQ scores improved from 44.67±9.28 to 29.73±7.00 in the HBPR group and from 38.70±10.35 to 25.10±8.30 in the HPR group (both p<0.001). Significant improvements were also observed in BMI, DASS-21 scores, forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, and forced expiratory flow between 25% and 75% of vital capacity predicted values. Although the greatest gains occurred during the first 12 weeks, several outcomes continued to improve between 12 and 24 weeks. Change-score analysis demonstrated comparable improvements between HBPR and HPR across most outcomes. This study concluded that both home-based and HPR significantly improved clinical, functional, psychological, and pulmonary outcomes in PTLD. Benefits extended beyond 12 weeks, with comparable improvements observed between rehabilitation strategies.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129347","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":"Divergent temporal trajectories of adiponectin and leptin in critically ill patients with COVID-19-associated acute respiratory distress syndrome.","authors":"Milka Jandric, Biljana Zlojutro, Danica Momcicevic, Sasa Dragic, Tijana Kovacevic, Nikola Sobot, Milos P Stojiljkovic, Ranko Skrbic, Pedja Kovacevic","doi":"10.4081/monaldi.2026.4003","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4003","url":null,"abstract":"<p><p>Adipokines play an important role in immunometabolic regulation and systemic inflammation, processes profoundly disturbed in COVID-19. Leptin and adiponectin have attracted particular interest because of their opposing biological effects. However, most studies have relied on single time-point measurements, and data on serial adipokine dynamics in critically ill patients with COVID-19-associated acute respiratory distress syndrome (ARDS) remain limited. This study aimed to evaluate circulating leptin and adiponectin concentrations and their temporal changes during the first week of intensive care unit (ICU) treatment. This single-center prospective observational study included 75 adults with COVID-19-associated ARDS admitted to the medical ICU (MICU). Serum leptin and adiponectin concentrations were measured on day 1 and day 7 using enzyme-linked immunosorbent assays. Clinical data, including respiratory support, vasopressor use, comorbidities, and 28-day survival, were prospectively collected. The overall 28-day mortality was 38.7%. Leptin concentrations did not significantly change between day 1 and day 7 in any subgroup. In contrast, adiponectin demonstrated significant temporal changes. Among non-survivors, adiponectin levels decreased markedly during the first week of MICU treatment (p<0.001), whereas no significant change was observed in survivors. Similar declines were observed in patients requiring invasive mechanical ventilation and vasopressor therapy, while patients managed without these interventions showed increasing adiponectin concentrations. The leptin-to-adiponectin ratio showed a trend toward higher values in non-survivors but did not reach statistical significance. In COVID-19-associated ARDS patients, adiponectin demonstrated dynamic changes associated with clinical deterioration, whereas leptin remained relatively stable. These findings suggest that serial adiponectin measurements may have potential for monitoring short-term disease progression in critically ill patients and warrant confirmation in larger prospective studies.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082816","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":"Epigenetic crosstalk between miR-144 and DNMT3A in the pathogenesis of chronic obstructive pulmonary disease: a narrative review.","authors":"Samjhana B, Reeta R, Muhamed Kamaludeen Muhamed Musthafa","doi":"10.4081/monaldi.2026.3844","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3844","url":null,"abstract":"<p><p>This review consolidates and evaluates current evidence on the epigenetic interaction between microRNA-144 [miR-144] and DNA methyltransferase 3A (DNMT3A) and its collective role in the pathogenesis of chronic obstructive pulmonary disease (COPD). The available literature was narratively synthesized to provide a comprehensive overview of the current evidence regarding the mechanistic, epigenetic, and clinical implications of miR-144 and DNMT3A in COPD. Across the included studies, miR-144 was consistently reported to be upregulated in smokers and individuals with COPD, with parallel findings demonstrating a reduction in DNMT3A expression and associated hypomethylation of key inflammatory gene promoters. Functional assays and mechanistic analyses further substantiated that miR-144 directly targets and suppresses DNMT3A, leading to impaired methyltransferase activity, dysregulated DNA methylation patterns, heightened oxidative stress, and enhanced secretion of pro-inflammatory cytokines. These molecular alterations collectively contribute to a self-sustaining cycle of chronic inflammation, epithelial injury, and airway remodeling, which are potential features of COPD progression. The literature that is now available indicates that DNMT3A-mediated epigenetic regulation and miR-144 dysregulation both contribute to important molecular processes implicated in the pathophysiology of COPD, such as oxidative stress, inflammation, and aberrant gene regulation. There is currently little direct mechanistic evidence connecting the miR-144-DNMT3A axis in COPD, despite the literature supporting the individual roles of these molecules. Therefore, rather than being a completely developed pathway, this regulatory interaction should be viewed as an evolving mechanistic framework. To fully understand its diagnostic, prognostic, and therapeutic potential in COPD, more experimental research, extensive clinical validation, and phenotype-specific studies are needed.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076590","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":"Associations of light smoking with serum carcinoembryonic antigen and relative leukocyte telomere length in men with asthma.","authors":"Sajedeh Sobhanparast, Alireza Herischi, Amir Amiri-Sadeghan, Jafar Soleymani, Maryam Shirforoush-Sattari, Maryam Seyyedi, Khalil Ansarin, Nader Chaparzadeh, Younes Aftabi","doi":"10.4081/monaldi.2026.3946","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3946","url":null,"abstract":"<p><p>Smoking and asthma are associated with oxidative stress and chronic inflammation, which may contribute to accelerated cellular aging. Relative leukocyte telomere length (RTL) and serum carcinoembryonic antigen (CEA) are accessible biomarkers linked to these pathways, but their associations with light smoking (1-4 cigarettes/day) in men with asthma remain unclear. This cross-sectional study included 156 men: 73 with asthma and 83 healthy controls, classified as asthmatic light smokers, asthmatic nonsmokers, healthy light smokers, or healthy nonsmokers. Primary analyses used outcome-specific datasets after within-group Tukey 1.5×IQR exclusion, yielding 150 observations for CEA and 148 for RTL; complete-data and age-restricted analyses were sensitivity analyses. CEA differed across groups and was higher in asthmatic light smokers than in healthy nonsmokers (Dunn-Bonferroni p=0.006). In the age-adjusted full-cohort model, light smoking among participants with asthma was associated with higher CEA [adjusted ratio 1.18, 95% confidence interval (CI) 1.01-1.38; p=0.034]. This association became statistically inconclusive after broader adjustment. RTL also differed across groups and was shorter in asthmatic light smokers than in asthmatic nonsmokers (Dunnett T3 p=0.001). In the primary median-regression model, light smoking among participants with asthma was associated with lower RTL (adjusted conditional-median ratio 0.38, 95% bootstrap CI 0.22-0.67; p=0.001), but this association was not consistently retained in severity-adjusted, complete-data, and age-restricted analyses. Asthma-status×smoking-status interactions were nonsignificant for both biomarkers. Light smoking was associated with higher CEA and lower RTL in the primary models, but both findings were sensitive to analytical specification. These exploratory cross-sectional associations do not establish causality and require longitudinal confirmation.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041927","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}