Pulmonology最新文献

{"title":"Prone positioning in acute respiratory distress syndrome: A critical review of clinical evidence and practical challenges.","authors":"Kwang Joo Park","doi":"10.1080/25310429.2026.2742715","DOIUrl":"https://doi.org/10.1080/25310429.2026.2742715","url":null,"abstract":"<p><strong>Background: </strong>Early randomised controlled trials (RCTs) of prone positioning (PP) in acute respiratory distress syndrome (ARDS) failed to demonstrate a survival benefit despite consistent improvements in oxygenation. Subsequent meta-analyses suggested a survival advantage in patients with severe hypoxaemia, culminating in the landmark Proning Severe ARDS Patients (PROSEVA) trial, which reported a 28-day mortality rate of 16.0% in patients with a PaO₂/FiO₂ ratio <150 mmHg. However, the optimal criteria for repeating and discontinuing PP sessions remain uncertain.</p><p><strong>Methods: </strong>A structured search of PubMed, Embase.com, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted to identify RCTs evaluating PP in adults with ARDS with mortality as a prespecified principal outcome. Relevant clinical studies, meta-analyses, and review articles were also evaluated to provide context for the narrative review.</p><p><strong>Results: </strong>Six RCTs were included in the main comparative analysis. Previous RCTs conducted before the PROSEVA trial used diverse protocols and treatment settings and did not demonstrate a survival benefit. Therefore, comparative assessments of these trials may provide valuable insights for optimising clinical practice. Based on a detailed comparison of the RCTs, the currently proposed benefits of early implementation of PP with prolonged duration may not fully explain the differences in outcomes observed across trials. Other potentially influential factors, including patient selection, timing, ventilatory management, centre experience, treatment delivery, and criteria for repeating and discontinuing PP sessions, warrant further evaluation in practical implementation studies. The development of automated equipment for PP may further improve procedural efficiency. This review critically examines both the positive and negative evidence regarding PP, highlighting methodological limitations and practical challenges to greater utilisation of PP.</p><p><strong>Conclusion: </strong>PP has established clinical value in severe ARDS, but important uncertainties remain regarding its optimal implementation. Concerted efforts are required to establish standardised protocols and to optimise implementation of PP in ARDS management.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2742715"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescaling oxygen flow measurement: A proposal for improved patient safety.","authors":"Ángel Ortega-González, Juana María Machado-Gallas, Francisco Rodríguez-Argente","doi":"10.1080/25310429.2026.2683325","DOIUrl":"https://doi.org/10.1080/25310429.2026.2683325","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2683325"},"PeriodicalIF":6.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adhesion molecules and T cell imbalance in severe eosinophilic asthma: Insights from anti-IL-5R treatment.","authors":"Laura Bergantini, Irene Paggi, Tommaso Pianigiani, Sara Biancucci, Miriana d'Alessandro, Elena Bargagli, Paolo Cameli","doi":"10.1080/25310429.2026.2641353","DOIUrl":"https://doi.org/10.1080/25310429.2026.2641353","url":null,"abstract":"<p><strong>Rationale: </strong>Severe eosinophilic asthma (SEA) is driven by type 2 (T2) inflammation, characterised by dysregulated cytokine release and aberrant expression of adhesion molecules involved in immune cell trafficking and activation. Despite the established role of intercellular adhesion molecules (ICAMs) and L-selectin (CD62L) in these processes, their dysregulation in SEA and their potential remodulation in response to biologic therapy remain unclear.To investigate the expression of adhesion molecules (ICAM-1, ICAM-3, CD62L) on T-cell subsets in SEA, their modulation by IL-25 and IL-33, and the immunological impact of benralizumab therapy.</p><p><strong>Methods: </strong>Peripheral blood from SEA patients and healthy controls were analysed using flow cytometry and live-cell imaging. A subset of patients was re-evaluated after 6 months of benralizumab therapy to assess changes in T-cell phenotype, adhesion molecule expression, proliferation, and cytotoxicity.</p><p><strong>Results: </strong>At baseline, SEA patients exhibited a marked Treg/Th2 imbalance, with increased ICAM-1 and CD62L expression on effector T cells and reduced ICAM-3 on Tregs. Alarmin stimulation enhanced ICAM-1 and CD62L expression on Th2 and Treg subsets and increased T-cell proliferation and cytotoxicity. After benralizumab therapy, Treg levels increased, and effector T-cell expression of ICAM-1, ICAM-3, and CD62L was significantly downregulated upon alarmin stimulation, suggesting a restoration of immune homoeostasis.</p><p><strong>Conclusion: </strong>SEA is associated with alarmin-driven dysregulation of adhesion molecule expression on T cells. Treatment with benralizumab induces an at least partial immunological rebalancing by indirectly modulating T-cell responses to epithelial-derived signals.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2641353"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak cardiorespiratory and metabolic responses during the six-minute stepper test in people with COPD: A pre-planned cross-sectional ancillary study.","authors":"Arthur Hinfray, Astrid Vanheule, Adrien Kerfourn, Antoine Cuvelier, Catherine Viacroze, David Debeaumont, Francis-Edouard Gravier, Tristan Bonnevie","doi":"10.1080/25310429.2026.2683324","DOIUrl":"10.1080/25310429.2026.2683324","url":null,"abstract":"<p><strong>Background: </strong>The six-minute stepper test (6MST) is increasingly used to assess functional exercise capacity in people with chronic obstructive pulmonary disease (COPD). However, the physiological responses elicited during the 6MST and their relationship to those obtained during cardiopulmonary exercise testing (CPET) remain incompletely characterised.</p><p><strong>Research question: </strong>How do peak cardiorespiratory and metabolic responses obtained during the 6MST compare with those measured during CPET, and does the 6MST elicit maximal physiological responses?</p><p><strong>Study design and method: </strong>This pre-planned ancillary cross-sectional study included individuals with COPD who performed incremental CPET and two 6MSTs with breath-by-breath gas exchange analysis. Peak responses as well as symptoms were compared between tests.</p><p><strong>Results: </strong>Sixty-five participants were included (mean age 61 (SD 9) years; median FEV₁ 1.3 (IQR 0.9 to 1.7) L). Most peak physiological responses were comparable and moderately to strongly correlated between the 6MST and CPET, with marked intraindividual variability in responses. Heart rate and symptom burden were similar to slightly higher during the 6MST, while systolic arterial blood pressure was clinically higher. Peak oxygen uptake corresponded to approximately 60% of predicted values during both tests, and about 10% of participants achieved conventional criteria for maximal cardiac and metabolic exercise during the 6MST. Ventilatory limitation was the predominant limiting factor during both tests.</p><p><strong>Interpretation: </strong>The 6MST elicits substantial but generally submaximal cardiac and metabolic stress, and provides complementary, rather than interchangeable, information to CPET. These findings support the clinical utility of the 6MST while highlighting the need for cautious cardiovascular monitoring.</p><p><strong>Clinical trial registration: </strong>NCT04008615.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2683324"},"PeriodicalIF":6.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of increased depressive symptoms and lung health in participants with pre-COPD: A population-based study.","authors":"Kefan Wu, Lifei Lu, Yubiao Chen, Cuiqiong Dai, Heshen Tian, Ying Wu, Yuelin Liu, Ailing Duan, Kaiheng Guo, Linghua Huang, Bingning Xu, Pixin Ran, Yumin Zhou","doi":"10.1080/25310429.2026.2703419","DOIUrl":"https://doi.org/10.1080/25310429.2026.2703419","url":null,"abstract":"<p><strong>Background: </strong>Depression is a common comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with worse prognosis. However, its association with lung health in individuals with pre-COPD remains unknown. We examined associations of increased depressive symptoms with respiratory symptoms, pre-COPD, and mortality.</p><p><strong>Methods: </strong>We analysed data from the National Health and Nutrition Examination Survey (NHANES 2007-2012). Non-COPD individuals with available spirometry and Patient Health Questionnaire-9 (PHQ-9) data were included. Pre-COPD phenotypes included small airway dysfunction (SAD), preserved ratio impaired spirometry (PRISm) and nonobstructive chronic bronchitis (NOCB). Logistic and Cox regression models assessed associations of increased depressive symptoms with respiratory outcomes and all-cause mortality, respectively.</p><p><strong>Results: </strong>Among 10 941 participants, increased depressive symptoms were associated with higher risk of PRISm (adjusted OR (aOR) [95% CI] 1.41[1.07,1.85]), NOCB (aOR [95% CI] 1.90[1.49,2.42]), cough (aOR [95% CI] 2.17[1.72,2.73]), phlegm production (aOR [95% CI] 2.86[2.23,3.67]), exertional dyspnoea (aOR [95% CI] 2.53[2.04,3.13]) and wheeze (aOR [95% CI] 1.86[1.51,2.30]). A one-unit increase in PHQ-9 score was also associated with higher risks of respiratory symptoms and pre-COPD. Additionally, increased depressive symptoms were independently associated with higher all-cause mortality risk among participants with pre-COPD, including SAD (aHR [95% CI] 2.85[1.02,7.95]), PRISm (aHR [95% CI] 2.02[1.01,4.01]) and NOCB (aHR [95% CI] 2.45[1.24,4.84]). Similar associations were observed across depression scores and pre-COPD populations.</p><p><strong>Conclusions: </strong>Increased depressive symptoms were associated with a higher risk of pre-COPD phenotypes, respiratory symptoms, and mortality. Increased depressive symptoms may be a treatable trait that can help mitigate adverse outcomes in participants with pre-COPD.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2703419"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on 'BMI-mediated association between pulmonary function and bone mineral density moderated by age: Integrated Mendelian randomisation and cross-sectional study'.","authors":"Jingyan Wei, Ruliu Xiong, Xingmao Zhou, Zhenyan Huang","doi":"10.1080/25310429.2026.2712194","DOIUrl":"https://doi.org/10.1080/25310429.2026.2712194","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2712194"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescaling oxygen flow units: An unproven behavioural premise and a new conversion risk.","authors":"Shalom Akhai","doi":"10.1080/25310429.2026.2711540","DOIUrl":"https://doi.org/10.1080/25310429.2026.2711540","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2711540"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence: Expanding the clinical implications of pectoralis muscle area assessment in COPD.","authors":"Anchal Thakur, Vaishali Rai, Kanika Bhatia","doi":"10.1080/25310429.2026.2615023","DOIUrl":"10.1080/25310429.2026.2615023","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2615023"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence: Dyspnoea anchoring and methodological considerations in inspiratory capacity based MCID estimation in COPD.","authors":"Nikita Vaid, Mandeep Kumar Jangra, Rittu Sharma","doi":"10.1080/25310429.2026.2623660","DOIUrl":"10.1080/25310429.2026.2623660","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2623660"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring symptoms and performance in rehabilitation: Can we detect COPD exacerbation?","authors":"Margaux Machefert, Yann Combret, Bertrand Selleron, Guillaume Galliou, Mathieu Delorme, Claire Dubois, Bouchra Lamia, Roger Hilfiker, Guillaume Prieur, Clément Medrinal","doi":"10.1080/25310429.2026.2742748","DOIUrl":"10.1080/25310429.2026.2742748","url":null,"abstract":"<p><strong>Background: </strong>In patients with COPD, exacerbations mark disease progression, with significant reduction in quality of life and impact on mortality. Early detection is crucial to mitigate their consequences. The aim of this study was to investigate whether monitoring symptoms and exercise endurance at each pulmonary rehabilitation maintenance session could predict severe exacerbations of COPD.</p><p><strong>Study design and methods: </strong>Prospective multicentre study including 128 stable COPD patients in maintenance pulmonary rehabilitation programmes, in 21 French rehabilitation centres (NCT05492149). At each session, symptoms with COPD Assessment Test (CAT), perceived dyspnoea (mBorg scale) and endurance exercise performance (in MET.minutes) were recorded. We evaluated whether these parameters could predict severe exacerbations using baseline and lagged logistic regression models, and explored temporal relationships with cross-lagged correlation analyses.</p><p><strong>Results: </strong>Over one year and 4,200 recorded sessions (33 ± 25 per patient), 19 out of 128 participants experienced a severe exacerbation (a prevalence of 14.8%). Prediction models using isolated clinical markers such as CAT, mBorg or performance showed limited predictive accuracy (AUCs 0.45-0.58; all <i>p</i> > 0.1). Cross-lagged analyses revealed weak, short-term associations between symptoms (CAT score), perceived dyspnoea (mBorg scale) and exercise performance.</p><p><strong>Conclusion: </strong>This study showed that nearly 15% of patients with COPD included in a maintenance rehabilitation programme experienced severe exacerbations during long-term follow-up. In this real-world maintenance pulmonary rehabilitation setting, routine clinical and isolated exercise data were insufficient to reliably predict severe COPD exacerbations. These findings highlight the complexity of severe exacerbations in COPD and emphasise the importance of developing more integrated research and digital monitoring strategies, using multimodal approaches that combine physiological, biological, behavioural, and environmental data.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2742748"},"PeriodicalIF":5.3,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}