Advances in respiratory medicine最新文献

{"title":"Left Ventricular Diastolic Dysfunction in Patients with Interstitial Lung Disease-A Potential Treatable Trait.","authors":"Ophir Freund, Uriel Katsoff, Tzlil Hershko, Ayala Ron, Shir Frydman, Doron Cohn-Schwartz, Aviv Kupershmidt, Neta Mano, Ariel Melloul, Eyal Kleinhendler, Amir Bar-Shai, Avraham Unterman","doi":"10.3390/arm94040057","DOIUrl":"10.3390/arm94040057","url":null,"abstract":"<p><p>Cardiovascular comorbidities complicate interstitial lung disease (ILD) and represent potential therapeutic targets, yet the prevalence and clinical impact of left ventricular diastolic dysfunction (LVDD) remain poorly characterized. We aimed to evaluate LVDD as a potential treatable trait within a prospective cohort. Using data from an ILD registry (January 2021-October 2024), we defined clinically relevant LVDD as echocardiographic grade 2 or 3 diastolic dysfunction. Out of 276 patients (median age 69, 44% female), 14% had LVDD, which was almost entirely in patients with fibrosis (97%, <i>p</i> = 0.045) and associated with lower diffusing capacity for carbon monoxide. Survival and clinical analyses restricted to the fibrotic ILD subgroup (<i>n</i> = 241) showed that LVDD was independently associated with a higher hazard for a combined adverse outcome of acute exacerbation, lung transplantation, or death (adjusted HR 1.82, 95% CI 1.03-3.38, <i>p</i> = 0.043), which persisted after 1:2 propensity score matching (HR 2.04). LVDD also independently predicted increased all-cause mortality (adjusted HR 2.10) and reduced 6-min walk distance (median 413 vs. 465 m, β = -0.14, <i>p</i> = 0.036). In conclusion, LVDD is prevalent in fibrotic ILD and carries significant prognostic implications. Given its objective measurability and actionable treatment pathways, LVDD represents a potentially important treatable trait requiring multi-disciplinary care.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timothy Grass Pollen-Specific Immunoglobulin E in Nasal Secretions During Natural Allergen Exposure and After a Nasal Provocation Test in Patients with Suspected Local Allergic Rhinitis.","authors":"Mohamad Mahdi Mortada, Waleed Aman Ur Rahman, Alaa Sherri, Gabriela Pawlak, Krystian Kowalski, Anna Piłat, Edyta Pietrowska, Marta Popławska, Iwona Dziembała-Gładysz, Barbara Majkowska-Wojciechowska, Marcin Kurowski","doi":"10.3390/arm94040056","DOIUrl":"10.3390/arm94040056","url":null,"abstract":"<p><strong>Introduction: </strong>Allergic rhinitis (AR) imposes a substantial burden on individuals worldwide. Local allergic rhinitis (LAR) patients exhibit symptoms similar to those of AR without a positive skin prick test (SPT) or the presence of sIgE specific to one or more allergens. Our study evaluated specific and total grass pollen IgE in the nasal secretions of patients with suspected LAR, examining the effects of natural pollen exposure and nasal provocation testing (NPT).</p><p><strong>Methods: </strong>Twenty-nine subjects (18 with suspected LAR and 11 with AR) were included in this study. The total nasal symptom score (TNSS) and visual analog scale (VAS) were used for subjective assessment. NPT was performed using grass pollen allergen. Nasal lavage was used to obtain nasal secretions, and the levels of sIgE and total IgE were measured.</p><p><strong>Results: </strong>During the exposure vs. the off-exposure period, the TNSS and VAS were significantly higher in LAR (<i>p</i> < 0.0001 and <i>p</i> = 0.0061, respectively). sIgE and total IgE were significantly higher in the AR group than in the LAR group during the exposure period (<i>p</i> = 0.0008 and <i>p</i> = 0.0491, respectively). LAR diagnosis was confirmed in seven subjects. TNSS and VAS scores were higher after a positive NPT. The median level of sIgE was lower in the negative and positive NPT. A higher median total IgE level was observed post-provocation in both groups. A significantly higher median relative sIgE level was noted after positive and negative provocation (<i>p</i> = 0.0156 and <i>p</i> = 0.0143, respectively).</p><p><strong>Conclusions: </strong>The assessment of local sIgE levels in nasal secretions can be used as a method for the diagnostic workup of patients with suspected LAR. Achieving a well-defined and standardized protocol for the assessment of sIgE concentrations in nasal secretions of LAR is a goal of future larger studies.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Really Benefits from CPAP? Disease Severity, Response Quality, and Long-Term Survival in Obstructive Sleep Apnea.","authors":"Wojciech Kuczyński, Karol Pierzchała, Weronika Bielska, Zuzanna Boczar, Aleksandra Kudrycka, Piotr Białasiewicz","doi":"10.3390/arm94040055","DOIUrl":"10.3390/arm94040055","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA) is associated with increased cardiovascular, respiratory, and all-cause mortality, yet the long-term survival impact of continuous positive airway pressure (CPAP) remains contested, and treatment is usually analysed as a binary exposure rather than by the quality of the response achieved. In a single-centre cohort of 4368 adults referred for polysomnography and followed for 8-20 years (prespecified subgroup with apnea-hypopnea index [AHI] ≥ 15, n = 2304), we applied cause-specific Cox and Fine-Gray competing-risks models, together with machine-learning classifiers, to characterise all-cause, cardiovascular, and pulmonary mortality. CPAP was associated with reduced all-cause (hazard ratio [HR] 0.75), cardiovascular (HR 0.75), and pulmonary mortality (HR 0.54), with the benefit confined to severe OSA (HR 0.66) and absent in moderate disease (HR 0.95). Good responders showed a significant 34% reduction in all-cause mortality (HR 0.66), whereas poor responders showed no significant reduction. Nocturnal desaturation (time with oxygen saturation < 90%) was the dominant independent predictor of pulmonary mortality, and baseline features predicted response category only moderately (macro-averaged AUC 0.76). Long-term CPAP confers a severity- and response-dependent survival benefit; nocturnal hypoxaemia is a key, modifiable driver of respiratory death.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microglia-Mediated Ependymal Injury in Bacille Calmette-Guérin-Induced Meningitis Is Attenuated by Sodium Butyrate with Restoration of Hmgcs2 Expression.","authors":"Yang Ren, Danni Chen, Shiqi Xie, Yawen He, Xuanru Zhuang, Dan Ye, Zhentao Fei, Lu Xia, Yongjie Wang, Feng Li","doi":"10.3390/arm94040054","DOIUrl":"10.3390/arm94040054","url":null,"abstract":"<p><strong>Background: </strong>Tuberculous meningitis (TBM) is the most severe form of central nervous system tuberculosis, associated with high mortality and neurological sequelae. Microglia-driven neuroinflammation is a key contributor to TBM pathogenesis; however, its specific effects on ependymal cells-critical for cerebrospinal fluid dynamics and barrier function-and potential therapeutic strategies remain unclear.</p><p><strong>Methods: </strong>A murine TBM model was established by tail vein injection of BCG. Although the virulence of BCG, an attenuated strain of Mycobacterium bovis, is different from that of clinically isolated human Mycobacterium tuberculosis, its induced phenotypes such as periventricular inflammatory infiltration, microglia activation, and ependymal dysfunction highly reproduce the key histopathological features of human TBM. Primary ependymal cells were cultured and treated either directly with BCG or indirectly with conditioned medium from BCG-stimulated BV2 microglial cells (BCG+BV2-CM). Transcriptomic profiling was conducted via RNA sequencing, with validation by qPCR and Western blot. Functional outcomes, including ciliary morphology and apoptosis, were assessed using immunofluorescence and flow cytometry. The therapeutic effect of sodium butyrate (NaB) was evaluated through pretreatment experiments.</p><p><strong>Results: </strong>BCG infection induced characteristic TBM pathology, with persistent bacteria in the brain and lungs, ventricular inflammation, and pulmonary damage. Transcriptomic analysis showed that direct BCG treatment altered the expression of 1036 genes in ependymal cells, whereas BCG+BV2-CM treatment induced 3558 differentially expressed genes, highlighting microglia's role in amplifying ependymal injury. Integrated analysis identified 64 consistently dysregulated genes across in vitro and in vivo models, enriched in immune and metabolic pathways. BCG challenge significantly downregulated Hmgcs2, leading to ciliary shortening and increased apoptosis. Sodium butyrate treatment restored Hmgcs2 expression, preserved ciliary structure, and reduced apoptosis.</p><p><strong>Conclusion: </strong>Microglia profoundly exacerbate transcriptional dysregulation in ependymal cells during TBM. Sodium butyrate confers protection against BCG-induced ependymal damage by upregulating Hmgcs2, revealing a novel therapeutic target for tuberculous meningitis.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Physical Function, Pulmonary Function, and Social Determinants of Health in Individuals with Post-Tuberculosis Lung Disease.","authors":"Nielza Moreira de Souza, Pedro Henrique Perpetuo de Lima Silva, Estephane Ramos de Souza Penna, Amanda Oliveira Dos Anjos, Alícia Sales Carneiro, Walter Costa, Bruna Cuoco Provenzano, Ana Paula Santos, Agnaldo José Lopes","doi":"10.3390/arm94040052","DOIUrl":"10.3390/arm94040052","url":null,"abstract":"<p><p>Although poverty and tuberculosis are insidiously linked, knowledge of the relationship between social determinants of health (SDoHs) and post-tuberculosis lung disease (PTLD) is limited. This study aimed to analyze the association between physical function, pulmonary function, and SDoHs in individuals with PTLD (iwPTLD), considering the impact of social inequalities on physical performance. This cross-sectional study collected social data from 69 iwPTLDs using a standardized assessment form. The patients underwent pulmonary function testing via spirometry and body plethysmography, as well as respiratory muscle strength and quadriceps muscle strength (QMS) testing. They also completed the six-minute step test (6MST). The median value of steps climbed by participants on the 6MST was 88 (57-117), corresponding to 50.1% (34.9-73.2) of the predicted value. The mean QMS was 28.7 ± 11.9 kgf, with 11 participants (17.4%) showing QMS below the cutoff point. Spirometry revealed normal, obstructive, restrictive, and mixed patterns in 19 (27.5%), 20 (29%), 18 (26.1%), and 12 (17.4%) of the participants, respectively. Performance on the 6MST showed no statistically significant association with SDoHs. QMS showed a statistically significant association with treated sewage (<i>W</i> = 84, <i>p</i> = 0.026). Forced expiratory volume in one second showed significant correlations with education level (<i>ρ</i> = 0.248, <i>p</i> = 0.040), social protection (<i>W</i> = 207, <i>p</i> = 0.050, <i>r</i> = 0.238), and treated water (<i>W</i> = 24.5, <i>p</i> = 0.029, <i>r</i> = 0.264). Maximum inspiratory pressure showed significant correlations with education level (<i>ρ</i> = 0.246, <i>p</i> = 0.042) and treated water (<i>W</i> = 20, <i>p</i> = 0.021, <i>r</i> = 0.280). The regression model for 6MST and QMS performance showed that 12% and 45% of the variability was explained by the studied variables, respectively. In iwPTLD, impairments in physical function and damage to lung function are weakly associated with the deterioration of SDoHs. While this relationship is weak, it should not be ignored because it may operate through indirect pathways.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awake Prone Positioning in Non-Intubated Non-COVID-19 ARDS: A Comprehensive Review.","authors":"Mairi Ziaka, Aristomenis Exadaktylos","doi":"10.3390/arm94040053","DOIUrl":"10.3390/arm94040053","url":null,"abstract":"<p><p>Despite advances in the understanding of the pathophysiology of acute respiratory distress syndrome (ARDS), treatment options remain limited and are mainly supportive, while mortality remains high. Prone positioning (PP) has been shown to improve oxygenation and lung mechanics in ARDS by reducing the imbalance in ventilation distribution between ventral and dorsal lung regions, altering pulmonary blood flow distribution, modifying the density distribution of edematous lung tissue, and limiting areas with low ventilation-perfusion ratios. During the coronavirus disease 2019 (COVID-19) pandemic, the use of PP, referred to as awake prone positioning (APP), was extended to non-intubated patients with severe hypoxemic respiratory failure. However, several concerns remain, including worsening oxygenation following the transition from prone to supine position, the potential development of patient self-inflicted lung injury (P-SILI), and delays in endotracheal intubation and initiation of invasive mechanical ventilation. Evidence regarding the use of APP in non-COVID-19 ARDS is scarce and consists mainly of small case series and a limited number of prospective studies with small and heterogeneous populations. Therefore, in the present work, we aim to summarize the existing evidence on APP in non-COVID-19 ARDS and acute hypoxemic respiratory failure (AHRF), describe the underlying pathophysiological mechanisms, and highlight areas for future research.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nanocarrier-Based Drug Delivery Systems for Lung Cancer: A Systematic Review and Meta-Analysis of Preclinical Studies.","authors":"Pranvera Breznica Selmani, Arlinda Daka Grapci, Blerina Koshi, Zana Sllamniku Dalipi, Rozafa Koliqi","doi":"10.3390/arm94040050","DOIUrl":"10.3390/arm94040050","url":null,"abstract":"<p><p>Drug delivery systems (DDS) may improve the therapeutic performance of chemotherapy in lung cancer, but their preclinical efficacy has not been quantitatively synthesized. We conducted a systematic review and meta-analysis of controlled in vivo mouse studies evaluating DDS-based chemotherapeutic formulations for lung cancer. Databases were searched from inception to 15 February 2025, and methodological quality was assessed using the SYRCLE risk-of-bias tool. Thirty studies comprising 47 experiments were included. Compared with corresponding free-drug treatments, DDS-based chemotherapy significantly reduced tumor volume (WMD -310.67 mm³; 95% CI: -375.51 to -245.83; <i>p</i> < 0.001), although substantial heterogeneity was observed. Both targeted and non-targeted DDS were associated with tumor growth inhibition, and targeted formulations showed a larger average reduction; however, this finding should be interpreted in light of differences in formulation properties, tumor models, and treatment protocols. Nanoparticle, liposomal, and micellar platforms all demonstrated significant antitumor effects, while combination DDS and docetaxel- or cisplatin-based systems showed large effects in subgroup analyses with variable sample sizes. These findings support the continued development of DDS-based chemotherapy for lung cancer, but standardized reporting of nanocarrier characterization, pharmacokinetics, biodistribution, toxicity, and rigorous animal-study design is required to improve reproducibility and translational relevance.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial Lung Disease in the United States: CDC Mortality Trends (1999-2024).","authors":"Palak Grover, Rahul Jain, Gurleen Kaur, Bipneet Singh","doi":"10.3390/arm94040051","DOIUrl":"10.3390/arm94040051","url":null,"abstract":"<p><p>Interstitial lung diseases (ILDs) comprise a heterogeneous group of pulmonary disorders associated with substantial morbidity and mortality. We examined mortality attributed to selected J84-coded ILDs in the United States from 1999 to 2024 using CDC WONDER underlying-cause-of-death data. Age-adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 U.S. population and stratified by sex and race. Joinpoint regression was used to identify changes in temporal slope and estimate annual percent change (APC), average annual percent change (AAPC), 95% confidence intervals (CIs), and <i>p</i>-values. After the removal of overlapping years between the CDC WONDER database series, 444,573 unique deaths occurred. Annual deaths increased from 11,358 in 1999 to 22,849 in 2024, while AAMR increased from 4.2 to 5.1 per 100,000. Overall, AAMR increased during 1999-2004 (APC 2.32%, 95% CI 1.39-3.26; <i>p</i> < 0.001) and more slowly during 2004-2024 (APC 0.36%, 95% CI 0.16-0.56; <i>p</i> = 0.001), with an overall AAPC of 0.75% (95% CI 0.60-0.90; <i>p</i> < 0.001). Male AAMRs remained higher than female AAMRs, while race-specific trends were heterogeneous. No temporal reduction in population mortality coincided with the introduction of antifibrotic therapies; however, this ecological analysis cannot evaluate treatment effectiveness or individual treatment exposure.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of ICD-10-Coded Pneumonia Events with Interstitial Lung Disease Outcomes in Patients with Rheumatoid Arthritis: A Large Database Retrospective Cohort.","authors":"Esteban Kosak Lopez, Luis Rodriguez Donís, Justin Lam, Andrew Geller, Raul Leguizamon, Michael Vera Ricaurte, Priscilla Nethala, Maria Planchart Ferretto, Maria Laura Fernandez-Wever, Jose M Martinez-Manzano, Enrique Pacheco, Shahrzad Abdollahi","doi":"10.3390/arm94040049","DOIUrl":"10.3390/arm94040049","url":null,"abstract":"<p><p><b>Introduction:</b> Patients with rheumatoid arthritis (RA) have higher risk for pneumonia, interstitial lung disease (ILD) and pulmonary fibrosis (PF). However, the association between an ICD-10-coded pneumonia event (CPE) and the incidence of ILD or PF in the RA population remains unclear. <b>Methods:</b> We conducted a retrospective cohort study using the TriNetX database. Patients with ICD-10 for RA aged 50 or older who had a CPE within one year of RA diagnosis (CPE cohort, n = 4553) were matched 1:1 by propensity score for key factors, including demographics, comorbidities (i.e., COPD), and medication use (DMARDs, corticosteroids) to RA patients without a CPE (Control cohort, n = 4553). Cox proportional hazard models assessed the incidence of a composite ILD outcome, PF, and secondary complications over a 4-year follow-up after the index event defined as 1-year after RA diagnosis for both cohorts. <b>Results:</b> The CPE cohort showed an increased risk for all outcomes. Patients with CPE had a 2.48-fold increased risk for PF (HR = 2.48; 95% CI, 1.78-3.45; <i>p</i> < 0.01) and a 2.87-fold increased risk for the composite ILD outcome (HR = 2.87; 95% CI, 2.18-3.80; <i>p</i> < 0.01). The risk of rheumatoid lung disease was 4.15 times higher (HR = 4.15; 95% CI, 2.30-7.50; <i>p</i> < 0.01). Furthermore, the CPE group had a higher risk for all-cause mortality (HR = 1.82; 95% CI, 1.58-2.09; <i>p</i> < 0.01). <b>Conclusions:</b> The CPE within one year of RA diagnosis is associated with an increase in subsequent ILD-coded outcomes. While this retrospective design cannot establish causality, an unspecified pneumonia code in early RA may represent an early clinical manifestation of unrecognized ILD, serving as a high-risk marker that warrants pulmonary surveillance.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Induced Deskilling in Interventional Pulmonology: An International Cross-Sectional Survey on Risk Perception and Mitigation Strategies.","authors":"Guido Marchi, Lorenzo Corbetta","doi":"10.3390/arm94040048","DOIUrl":"10.3390/arm94040048","url":null,"abstract":"<p><p>Artificial intelligence (AI) is progressively reshaping interventional pulmonology (IP), yet its potential to erode procedural and cognitive competencies through AI-induced deskilling remains poorly characterized in this specialty. An international, observational, cross-sectional survey was conducted in May 2026 among 118 expert interventional pulmonologists from 10 different countries across 5 continents. Participants completed a structured questionnaire comprising five demographic items and 12 Likert-scale statements addressing deskilling risk perception and mitigation attitudes; percentage agreement was calculated for each item (scores 4-5). High perceived clinical value of AI was reported (87%), alongside substantial concern for procedural deskilling (73%) and upskilling inhibition (83%). Familiarity with automation bias was limited (38%), yet its clinical relevance was widely recognized after definition provision (81%)-a gap of 43 percentage points. Strong support emerged for AI-free training (84%), simulation-based training (86%), and longitudinal performance monitoring (78%). Concern for institutional fragility in the absence of AI was expressed by 74%, and governance frameworks, including minimum non-AI-assisted procedural volume requirements, were endorsed by 70%. Deskilling was identified as a high research priority by 89%. These findings indicate that AI-induced deskilling is perceived as a relevant and emerging risk by expert interventional pulmonologists internationally, even before the widespread clinical deployment of AI technologies. Although the extent to which these concerns will translate into measurable effects on procedural competence is currently uncertain, the results underscore the need for prospective research, educational initiatives, and appropriate governance frameworks to ensure the preservation of core procedural skills.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":"94 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}