BMC Pulmonary Medicine最新文献

{"title":"Interstitial lung disease induced by Toripalimab combined with disitamab Vedotin in upper tract urothelial carcinoma: a case report and literature review.","authors":"Peng Ding, Huanhuan Lin, Kaichen Zhang, Qian Yang, Peiyang Gao","doi":"10.1186/s12890-025-03838-z","DOIUrl":"https://doi.org/10.1186/s12890-025-03838-z","url":null,"abstract":"","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"351"},"PeriodicalIF":2.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the global burden of interstitial lung disease and pulmonary sarcoidosis using multiple statistical models: analysis and future projections.","authors":"Luna Zhao, Yue Zhou, Yun Jia, Lang Wang, Ye Liu, Guizhen Lv, Yihao Zhang, Jinyang Li, Junfeng Ren, Hongzheng Liu, Yufeng Zhang, Ning Wang, Wenwen Zhang, Wenqiang Mo, Jiaqi Liu, Yilin Wang, Junhao Ma, Chao Wu, Dong Liu","doi":"10.1186/s12890-025-03813-8","DOIUrl":"https://doi.org/10.1186/s12890-025-03813-8","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung disease (ILD) and pulmonary sarcoidosis (PS) constitute major global health challenges, characterized by progressive respiratory symptoms and diverse epidemiological trends. Although the incidence and mortality rates of ILD and PS have increased following the COVID-19 pandemic, comprehensive research examining their burden and associated risk factors remains limited. Therefore, the present study aimed to analyze the spatiotemporal distribution, gender-specific and age-related disparities, and sociodemographic determinants of ILD and PS from 1990 to 2021 to facilitate evidence-based targeted interventions.</p><p><strong>Methods: </strong>By using data from the Global Burden of Disease 2021 database, we analyzed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year rate (ASDR) across 204 countries/regions. Temporal trends were evaluated using average annual percentage change (AAPC), age-period-cohort (APC), and Bayesian APC (BAPC) models. Decomposition analysis and Pearson's correlation analysis were conducted to assess the impact of aging, population growth, and sociodemographic index (SDI). Joinpoint regression was used to identify inflection points in trends. Future disease burdens (2021-2050) were projected through BAPC modeling.</p><p><strong>Results: </strong>Global ILD and PS cases increased from 157,441.17 in 1990 to 390,267.11 in 2021, with an annual increase in ASIR, ASMR, and ASDR by 0.61%, 1.32%, and 0.83%, respectively. High-SDI regions exhibited the highest ASIR (71.4/100,000) and ASMR (25.5/100,000). Males exhibited greater disease burdens than females ASDR 57.79/100,000 vs. 39.49/100,000 in 2021), with a peak incidence in the 70-74 age group. SDI showed positive correlations with ASIR and ASMR, exhibiting U-shaped relationships in certain regions. Projections indicated stable ASMR but increasing ASIR and ASDR by 2050, particularly among males.</p><p><strong>Conclusions: </strong>The global burden of ILD and PS has increased markedly since 1990, influenced by population aging, industrial development, and socioeconomic disparities. Prioritizing early screening (e.g., high-resolution computed tomography and serum biomarkers), minimizing environmental and occupational exposures, and implementing gender-/age-specific interventions are critical measures. Strengthening healthcare infrastructure in low-SDI regions and integrating advanced diagnostic technologies are crucial for reducing future disease burdens.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"352"},"PeriodicalIF":2.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PD-1/PD-L1 inhibitors monotherapy vs. combination therapy in elderly advanced NSCLC: a real-world study and nomogram for survival prognosis.","authors":"Yunye Mao, An Wang, Xiangwei Ge, Jinzhao Zhai, Yi Hu, Jinliang Wang","doi":"10.1186/s12890-025-03791-x","DOIUrl":"10.1186/s12890-025-03791-x","url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy with PD-1/PD-L1 inhibitors has transformed advanced non-small cell lung cancer (NSCLC) treatment, yet optimal strategies for elderly patients remain uncertain. Elderly patients (≥ 65 years) exhibit immune senescence (e.g., T-cell dysfunction, chronic inflammation), which may compromise immunotherapy efficacy and amplify toxicity risks, yet direct comparisons of monotherapy versus combination regimens in this population are lacking. Real-world comparisons of monotherapy versus combination therapy in this vulnerable group are lacking, hindering personalized clinical decisions.</p><p><strong>Objective: </strong>This real-world study aimed to compare the efficacy and safety of PD-1/PD-L1 inhibitor monotherapy versus combination therapy with chemotherapy in elderly patients (≥ 65 years) with advanced NSCLC and develop a prognostic nomogram to guide personalized treatment decisions.</p><p><strong>Methods: </strong>In this multicenter retrospective study, 641 patients (149 monotherapy, 492 combination therapy) with stage IIIB/IV NSCLC were analyzed. Primary endpoints included overall survival (OS), progression-free survival (PFS), and adverse events (AEs). A nomogram incorporating clinical variables was constructed using LASSO-Cox regression.</p><p><strong>Results: </strong>In a retrospective analysis of 641 elderly patients (≥ 65 years) with advanced NSCLC, combination therapy (n = 492) demonstrated superior median OS compared to monotherapy (n = 149) (35.37 vs. 20.53 months; HR = 0.62, 95% CI 0.48-0.80, P < 0.001), though PFS did not differ significantly (11.87 vs. 10.67 months; HR = 0.94, P = 0.535). Age-stratified analysis revealed marked OS benefits for patients < 75 years receiving combination therapy (36.10 vs. 18.67 months, P < 0.001), whereas no advantage was observed in those ≥ 75 years (29.23 vs. 34.93 months, P = 0.645). Cox regression identified combination therapy as a protective factor (HR = 0.54, P < 0.001), while ECOG PS ≥ 2 (HR = 1.87, P = 0.002), liver metastasis (HR = 1.62, P = 0.013), bone metastasis (HR = 1.84, P < 0.001), and malignant pleural effusion (HR = 1.64, P < 0.001) independently worsened prognosis. The incidence of AEs of any-grade (P < 0.001) and grade 3-4 (P = 0.003) in the immunotherapy combination group was significantly higher than that in the immunotherapy monotherapy group. A prognostic nomogram integrating treatment type, ECOG PS score, and other six variables had an AUC value of 0.70-0.71 for predicting 1-2 year OS.</p><p><strong>Conclusions: </strong>For elderly patients with advanced NSCLC, immune combination therapy improved median OS over monotherapy. It was safe and effective, suggesting a viable treatment option, though further evaluation is needed for those aged 75 and older. A prognostic nomogram for OS following immunotherapy was developed, showing superior accuracy.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"350"},"PeriodicalIF":2.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining ventilator-associated pneumonia treatment: a novel economic analysis of tobramycin and colistin's cost-effectiveness.","authors":"Jefferson Antonio Buendía, Juan Antonio Buendia Sánchez, Diana Guerrero Patino","doi":"10.1186/s12890-025-03797-5","DOIUrl":"https://doi.org/10.1186/s12890-025-03797-5","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a significant clinical challenge due to its morbidity, mortality, and economic burden, especially in low- and middle-income countries. This study evaluates the cost-utility of tobramycin and colistin as nebulized adjunct therapies to systemic antibiotics for managing VAP in Colombia.</p><p><strong>Methods: </strong>A decision tree model was constructed comparing three interventions: tobramycin + systemic antibiotics, colistin + systemic antibiotics, and systemic antibiotics alone. The model used a one-year time horizon from a third-payer perspective. Clinical probabilities, costs, and utilities were sourced from literature and local databases. Sensitivity analyses (deterministic and probabilistic with 10,000 iterations) assessed uncertainty. Costs were reported in 2023 USD, adjusted by GDP deflator.</p><p><strong>Results: </strong>Tobramycin demonstrated the highest cost-effectiveness. Incremental QALYs were 0.06 for tobramycin and 0.02 for colistin; incremental costs were US$338.09 and US$130.63, respectively. The ICER was US$5625.86 for tobramycin and US$5422.31 for colistin. At a willingness-to-pay threshold of US$5180/QALY, tobramycin had a 56.5% probability of being cost-effective.</p><p><strong>Conclusion: </strong>Tobramycin is more cost-effective than colistin as an adjunctive nebulized treatment for ventilator-associated pneumonia (VAP) in Colombia. These findings may help inform clinical guidelines and reimbursement decisions. Further research is needed to evaluate long-term outcomes and to incorporate utility data specific to the Colombian population.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"347"},"PeriodicalIF":2.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of combined nebulization of unfractionated heparin, acetylcysteine, budesonide and ipratropium bromide in hospitalised patients with COVID-19 pneumonia: a randomized controlled clinical trial.","authors":"Junhui Gong, Naifu Nie, Minrui Jiang, Xinyu Yang, Qinghua Wang, Jia Deng, Jun Kang, Xin Li, Li Zhang, Ying Zhang, Nuo Luo, Xiaoyi Du, Ling Wang, Wei Zhou, Hui Cao, Kunlin Li, Guoqiang Cao, Li Li","doi":"10.1186/s12890-025-03824-5","DOIUrl":"10.1186/s12890-025-03824-5","url":null,"abstract":"<p><strong>Background: </strong>Promoting the absorption of COVID-19 pneumonia is critical for reducing pulmonary sequelae and improving prognosis. This study aimed to evaluate the efficacy and safety of nebulized unfractionated heparin, acetylcysteine, budesonide, and ipratropium bromide (HABIT) in hospitalized patients with COVID-19 pneumonia.</p><p><strong>Methods: </strong>This single-center, open-label, randomized, parallel-group trial was conducted at a tertiary hospital in China. Participants were randomized 1:1 to receive either standard of care (SOC) or SOC plus nebulized HABIT. The HABIT protocol included daily quadruple nebulization for seven days, comprising 6000 units heparin sodium, 2 mg budesonide, 0.3 g acetylcysteine, and 0.5 mg ipratropium bromide. The primary outcome was the change in lung lesions assessed by chest CT scans on admission (Day 0) and post-treatment (Day 8).</p><p><strong>Results: </strong>A total of 74 patients were randomized to the HABIT group (n = 37) or the control group (n = 37). Four patients per group were excluded during follow-up, leaving 66 patients for final analysis. Baseline CT scores were comparable between groups (10.55 ± 3.11 vs. 10.76 ± 2.85, p = 0.774). Post-treatment, the HABIT group showed significantly lower mean CT scores (6.6 ± 2.98 vs. 8.69 ± 2.53, p = 0.003) and greater lesion absorption (37.5% vs. 20%, p < 0.001) compared to controls. The HABIT group also exhibited a non-significant improvement in PaO₂/FiO₂ (75.27 vs. 51.23, p = 0.113). Safety analysis showed no significant differences in activated partial thromboplastin time or serious adverse events.</p><p><strong>Conclusion: </strong>The adjunctive HABIT regimen demonstrates favorable efficacy and safety in treating COVID-19 pneumonia.</p><p><strong>Trial registration: </strong>The clinical trial was registered with the Chinese Clinical Trial Registry (ChiCTR; www.chictr.org.cn ; ID: ChiCTR2300073871) on July 24, 2023. Ethical approval was valid from May 2023 to May 2025.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"346"},"PeriodicalIF":2.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endobronchial biopsies in patients receiving clopidogrel and aspirin treatment.","authors":"Bilal Rabahoğlu, Nuri Tutar, Nur Aleyna Yetkin, Burcu Baran, İnci Gülmez","doi":"10.1186/s12890-025-03844-1","DOIUrl":"https://doi.org/10.1186/s12890-025-03844-1","url":null,"abstract":"<p><strong>Background: </strong>Some patients undergoing pulmonary procedures are on at least one antiplatelet or anticoagulant agent. Discontinuing these treatments can be challenging due to the risk of severe complications, particularly following acute coronary event. While studies indicate that clopidogrel cessation is necessary before transbronchial biopsy, others suggest it may be safely continued for procedures such as endobronchial ultrasound-guided transbronchial needle aspiration. There is limited literature on performing endobronchial biopsies while patients are on clopidogrel (a P2Y12 inhibitor), with only one case report available.</p><p><strong>Case presentation: </strong>In our three cases, the patients had endobronchial lesions causing partial or complete airway obstruction, leading to severe dyspnea and wheezing. Two of the patients were on dual antiplatelet therapy (DAPT) due to recent coronary artery syndrome treated with coronary stents, while the third was receiving the same treatment for peripheral artery disease managed with a stent. Endobronchial biopsies (EBB) were performed on all three patients without any major complications.</p><p><strong>Conclusion: </strong>Although it is typically recommended to discontinue clopidogrel 5-7 days prior to the procedure, early diagnosis and treatment are crucial in certain cases. In these situations, where the benefits may outweigh the risks, EBB can be performed with appropriate precautions. Through our case reports, we aim to encourage further prospective studies and the establishment of updated guidelines, particularly concerning EBB in patients receiving DAPT.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"349"},"PeriodicalIF":2.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary arterial hypertension with cardiopulmonary comorbidities: is it a unique phenotype?","authors":"Meng Zhang, Xueran Guo, Wei Guo, Yan Wang, Yao Xiao, Jiancheng Han, Ye Li, Tingting Man, Jie Li, Yong Chen, Shengchen Duan, Wenmei Zhang, Hui Li, Ao Yin, Jiafei Peng, Chunrong An, Wanmu Xie, Qian Gao, Shuai Zhang, Yunxia Zhang, Zhenguo Zhai, Jun Wan","doi":"10.1186/s12890-025-03833-4","DOIUrl":"https://doi.org/10.1186/s12890-025-03833-4","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) patients with cardiopulmonary comorbidities have been prevalent nowadays. However, there was limited data on clinical characteristics and therapeutic responses in these populations.</p><p><strong>Methods: </strong>Patients diagnosed with right heart catheterization (RHC)-confirmed PAH between October 2021 to March 2023 were included in our study. According to whether they had cardiopulmonary diseases or not, they were classified into two groups: comorbidities group and non-comorbidities group. We aimed to compare the clinical data, PAH-targeted strategies, and therapeutic responses between these two PAH groups. We further analyzed the impact of the numbers and categories of comorbidities on therapeutic responses.</p><p><strong>Results: </strong>Almost half of the patients co-existed with cardiopulmonary diseases. Compared with non-comorbidities group (n = 40), comorbidities group (n = 36) were senior (p = 0.000) and male predominantly (p = 0.005). Comorbidities group also associated inconsistencies between hemodynamics and 6-min walking distance (6MWD), with a shorter 6MWD (p = 0.000), but a lower mean pulmonary artery pressure (mPAP) (p = 0.008). Non-comorbidities group showed an upturn in the WHO-FC (p = 0.010) and risk assessment (p = 0.033), while the improvement of hemodynamics [decreased mPAP (p = 0.009) and pulmonary vascular resistance (PVR) (p = 0.001), increased cardiac index (p = 0.001)] in comorbidities group did not match the change in clinical severity (no significant improvements in WHO-FC, risk stratification and 6MWD). When categorized by the comorbidities counts, it demonstrated that the more comorbidities, the more severe the clinical conditions, and the worse the therapeutic responses.</p><p><strong>Conclusion: </strong>PAH patients with cardiopulmonary comorbidities represent a unique phenotype, with different clinical manifestation and treatment responses from typical PAH and inconsistencies between hemodynamics and functional status from baseline to follow-up.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"348"},"PeriodicalIF":2.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tetrandrine slows disease progression on high-resolution computed tomography and lung function decline in artificial stone-associated silicosis: a retrospective cohort study.","authors":"Shaowei Zhou, Jin Shi, Zidan Chen, Luqin Bian, Limin Huang, Ling Mao","doi":"10.1186/s12890-025-03821-8","DOIUrl":"10.1186/s12890-025-03821-8","url":null,"abstract":"<p><strong>Background: </strong>Silicosis, a progressive fibrotic lung disease caused by silica dust inhalation, is a significant occupational health concern, particularly among artificial quartz stone workers. Tetrandrine, a bisbenzylisoquinoline alkaloid, is the only plant-derived drug approved for the treatment of silicosis in China. The present study aimed to evaluate the efficacy of tetrandrine in slowing the progression of artificial stone-associated silicosis.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients were divided into an observation group (n = 53), which received tetrandrine (60 mg, 3 times daily for 6 consecutive days, followed by a 1-day break, with each cycle lasting 3 months), and a control group (n = 26), which received only symptomatic treatment. High-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were performed at baseline and after 12 months of treatment. Progression, stability, or improvement in HRCT findings and changes in PFT parameters were analyzed. Continuous variables and categorical variables were analyzed using the t-test and chi-square test, respectively, for statistical comparisons.</p><p><strong>Results: </strong>After 12 months, 49.1% of patients in the observation group exhibited improvement in HRCT findings, compared to none in the control group, in which 84.6% of individuals exhibited progression. PFT findings improved in the observation group, whereas they significantly declined in the control group (p < 0.001). Patients treated with tetrandrine for more than 6 months experienced greater improvements in HRCT findings and pulmonary function than those in the control group. Adverse reactions to tetrandrine, including facial pigmentation and liver function abnormalities, were mild.</p><p><strong>Conclusions: </strong>Tetrandrine significantly mitigated HRCT-detected disease progression and lung function decline in patients with artificial stone-associated silicosis, particularly after prolonged treatment. These findings suggest that tetrandrine may serve as a viable therapeutic option for managing artificial stone-associated silicosis.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"343"},"PeriodicalIF":2.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of triple therapy on mortality and cardiovascular risk in patients with moderate to severe COPD: a meta-analysis of randomized controlled trials.","authors":"Yubing Li, Jun Li, Hongxia Yang, Yong Zhang","doi":"10.1186/s12890-025-03823-6","DOIUrl":"10.1186/s12890-025-03823-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic obstructive pulmonary disease (COPD), the third leading cause of global mortality, remains a significant challenge in long-term management. While dual bronchodilators (LAMA/LABA) and inhaled corticosteroid combination therapies (ICS/LABA) alleviate symptoms, patients continue to face elevated risks of all-cause mortality and cardiovascular events. Recent studies suggest that triple therapy (ICS/LAMA/LABA) may improve outcomes by reducing acute exacerbations and systemic inflammation. However, its long-term effects on mortality and cardiovascular safety remain controversial, highlighting the critical need for systematic evidence to inform clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of PubMed, Embase, and the Cochrane Library (up to July 2024) identified 13 randomized controlled trials (RCTs) comparing triple therapy with dual therapies (LAMA/LABA or ICS/LABA) in patients with moderate-to-severe COPD. Outcomes included all-cause mortality, exacerbation rates, and cardiovascular adverse events of special interest (CVAESI). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models based on heterogeneity (assessed via I² statistics). Subgroup analyses explored heterogeneity across drug combinations, supplemented by sensitivity analyses and publication bias assessments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared to LAMA/LABA dual therapy, triple therapy significantly reduced all-cause mortality (RR = 0.76, 95% CI = 0.60-0.97, p = 0.03), moderate-to-severe exacerbation risk (RR = 0.93, 95% CI = 0.90-0.97, p = 0.0003), and overall CVAESI incidence (RR = 0.75, 95% CI = 0.61-0.93, p = 0.008), with a 38% reduction in severe CVAESI (hospitalized or fatal events: RR = 0.62, 95% CI = 0.45-0.86, p = 0.004). Subgroup analyses demonstrated that the BGF regimen achieved superior reductions in CVAESI (RR = 0.72, 95% CI = 0.58-0.89, p = 0.003) and severe CVAESI (RR = 0.61, 95% CI = 0.47-0.79, p = 0.0002) compared to other triple therapies. Although BGF showed only a nonsignificant trend toward mortality reduction (RR = 0.77, 95% CI = 0.58-1.03, p = 0.08), it exhibited greater efficacy in reducing exacerbations (RR = 0.72 vs. non-BGF regimens) and cardiovascular risks. Non-BGF triple therapies yielded inconclusive results due to limited sample sizes and substantial heterogeneity (I²=62-83%, subgroup difference p &lt; 0.05). Sensitivity analyses confirmed the stability of pooled estimates (&lt; 5% variation upon study exclusion), with no significant publication bias detected via funnel plots or Begg's test (p &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study confirms that ICS/LAMA/LABA triple therapy significantly reduces mortality, exacerbations, and cardiovascular risks in moderate-to-severe COPD compared to LAMA/LABA dual therapy. The BGF regimen, with optimized drug delivery and synergistic anti-inflammatory/bronchodilatory effects, shows superior","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"345"},"PeriodicalIF":2.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery after neoadjuvant therapy in patients with resectable stage IIIB/N2 non-small cell lung cancer.","authors":"Mithat Fazlıoglu, Volkan Erdogu, Necati Citak, Nevin Fazlıoglu, Muzaffer Metin","doi":"10.1186/s12890-025-03822-7","DOIUrl":"10.1186/s12890-025-03822-7","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the role of surgery in selected stage IIIB/N2 non-small cell lung cancer (NSCLC) patients within a multimodal treatment approach. We focused on the impact of mediastinal downstaging, local tumor invasion, and postoperative complications on survival outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1752 NSCLC patients who underwent surgery between 2010 and 2016. Among them, 49 patients with clinical stage IIIB/N2 NSCLC were identified based on single-station, non-bulky N2 disease confirmed by invasive staging and anatomically resectable tumors. Patients were grouped by T stage and mediastinal downstaging status following neoadjuvant therapy. Survival outcomes were analyzed using Kaplan-Meier and Cox regression models.</p><p><strong>Results: </strong>The overall 5-year survival (OS) rate was 29.2% (median 23 months), and the 5-year disease-free survival (DFS) rate was 22.0% (median 12.4 months). While patients with non-invasive T3 tumors had better OS and DFS than those with invasive T3 or T4 tumors, the differences were not statistically significant. Mediastinal downstaging was associated with improved OS (p = 0.049). Multivariate analysis identified local tumor invasion (HR: 2.15, p = 0.045) and early postoperative complications (HR: 2.93, p = 0.011) as independent predictors of worse OS.</p><p><strong>Conclusions: </strong>Surgical resection may be a viable option in highly selected cIIIB/N2 NSCLC patients-particularly those who respond well to neoadjuvant therapy and are anatomically resectable. However, tumor invasion and postoperative complications negatively affect survival. These findings underscore the importance of precise patient selection and perioperative management. Further prospective studies are needed to validate the role of surgery in this subset, especially in the context of evolving systemic therapies.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"344"},"PeriodicalIF":2.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}