BMC Pulmonary Medicine最新文献

{"title":"Decoding the shared genetic liability of lower respiratory tract infections via genomic structural equation modeling.","authors":"Ying Lei, Jin Li, Jia Xie, Tao Wang","doi":"10.1186/s12890-026-04476-9","DOIUrl":"10.1186/s12890-026-04476-9","url":null,"abstract":"<p><strong>Background: </strong>Lower respiratory tract infections (LRTI), including pneumonia, tuberculosis, and COVID-19, share overlapping clinical features and risk factors, yet their common genetic architecture remains poorly understood.</p><p><strong>Methods: </strong>We applied genomic structural equation modeling (Genomic SEM) to dissect the shared genetic susceptibility among seven LRTI-related phenotypes using large-scale GWAS summary statistics. Multivariate GWAS (mvGWAS) was performed to identify variants associated with the latent LRTI factor. Post-GWAS analyses included Bayesian fine-mapping, transcriptome-wide association studies, MAGMA analysis, pathway enrichment, and cell-type specific heritability partitioning.</p><p><strong>Results: </strong>A single latent factor model demonstrated excellent fit, confirming substantial genetic overlap across LRTI phenotypes. The mvGWAS identified 5,469 genome-wide significant variants, including 3,705 associations uniquely identified at the latent-factor level. Fine-mapping prioritized high-confidence causal variants at CAMK2D, NFKB1, CNTN5 and PARK2 loci, implicating calcium signaling, NF-κB-mediated inflammation, neuroimmune regulation, and mitochondrial quality control. TWAS highlighted TLK2, NUDT6, and PKN2 as key transcriptional regulators involved in chromatin homeostasis and inflammasome modulation. MAGMA identified RPL18A, HLA-DRB1, HLA-DQB1, and PTPN6, underscoring roles of ribosomal function, antigen presentation, and immune cell signaling. Pathway analysis revealed enrichment in coagulation cascades, while cell type analysis suggested involvement of hematopoietic progenitors and myeloid lineages.</p><p><strong>Conclusions: </strong>This study provides the first comprehensive genetic framework for shared LRTI susceptibility, revealing convergent biological pathways spanning inflammation, mitochondrial homeostasis, antigen presentation, and coagulation. These findings offer candidate targets for host-directed therapeutic strategies.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395851","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":"Clofazimine use for nontuberculous mycobacterial infections: 10-year experience in Belgium.","authors":"Astrid Piot, Sophie Missault, Yannick Vande Weygaerde, Nityanand Jain, Pascal Van Bleyenbergh, Cedric Bosteels, Isabel Spriet, Franky Buyle, Eva Van Braeckel, Natalie Lorent","doi":"10.1186/s12890-026-04461-2","DOIUrl":"10.1186/s12890-026-04461-2","url":null,"abstract":"<p><strong>Background: </strong>Clofazimine is increasingly recommended for nontuberculous mycobacterial (NTM) infections, despite limited evidence. In Belgium, until July 2025 access to clofazimine - outside of procurement by the national tuberculosis program - was restricted and associated with financial and administrative hurdles, creating barriers for patients.</p><p><strong>Methods: </strong>This retrospective, multicentre study documents clofazimine use from January 2015 to December 2024 through pharmacy and medical record review at Belgium's two largest tertiary care hospitals. Collected data included indications, treatment duration, adverse events and logistic aspects related to access. Data was summarized using descriptive statistics.</p><p><strong>Results: </strong>Among 102 clofazimine-containing treatment courses for NTM disease (61 in UZ Leuven; 41 in UZ Gent), the median patient age was 62 years; 52% were female, 56% had bronchiectasis, 28% COPD and 12% cystic fibrosis. Clofazimine was mainly used for NTM-pulmonary disease (NTM-PD) (n = 82, 87.2%), with main indications being M. abscessus complex-PD (MAB-PD; 28%), advanced or refractory M. avium complex-PD (MAC-PD; 17% and 12.2% respectively) or intolerance to another key drug (26.8%). Clofazimine was part of at least a triple-drug regimen, with 100 mg daily used in 91% of regimens for a median duration of 270 days (IQR 109-527 days). Common adverse events included ichthyosis/skin hyperpigmentation (38.3%) and gastrointestinal complaints (52.1%). Although none were severe, 20% of patients discontinued treatment prematurely. Financial reimbursement requests were submitted for 68.2% of NTM-PD treatments.</p><p><strong>Conclusion: </strong>Our study observed that clofazimine is prescribed largely in accordance with current guideline recommendations. Given its acceptable tolerability and the recent introduction of national health insurance coverage, clofazimine use is likely to increase in Belgium, with the potential to improve patient outcomes.</p><p><strong>Trial registration: </strong>This study did not involve a health care intervention and did not meet criteria for clinical trial registration. It was conducted as a retrospective, multicentre study at UZ Leuven and UZ Gent. Ethical approval was obtained from the Ethics Committee of UZ/KU Leuven (MP034837, S70431) and the Ethics Committee of UZ Gent (S61188, S62926).</p><p><strong>Clinical trial number: </strong>not applicable.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403757","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":"Study protocol: a 52-week, multicentre, observational, prospective study on the use of a smart platform connected to a single-inhaler triple therapy (ICS/LABA/LAMA) to evaluate effectiveness on treatment adherence and inhaler technique in patients with poorly controlled asthma.","authors":"Jonas Aggerholm Baekdal, Nicolai Krogh, Gajanan Sakhare, Elisabeth Bendstrup, Charlotte Suppli Ulrik, Johannes Martin Schmid","doi":"10.1186/s12890-026-04454-1","DOIUrl":"10.1186/s12890-026-04454-1","url":null,"abstract":"<p><strong>Background: </strong>Good adherence to controller medication and correct inhaler technique is essential for effective asthma management. However, many patients struggle with these aspects, leading to poor symptom control and a higher risk of exacerbations. This study (SiASMARTer) aims to evaluate the impact of the SiA®SMARTer platform - a digital smart platform consisting of an app and an add-on module connected to a pressurized metered-dose inhaler delivering triple therapy (ICS/LABA/LAMA) - on improving adherence and inhaler technique in patients with poorly managed inflammation in asthma (defined as fractional exhaled nitric oxide [FeNO] > 25 ppb).</p><p><strong>Methods: </strong>This observational study will enrol 60 patients from two sites in Denmark. At baseline, participants will begin using the SiA®SMARTer platform, which includes, on the patient side a smart inhaler cap, a patient app and on the physician side a dashboard. The primary endpoint, with follow-up at 12 and 52 weeks, is the platform's effect on FeNO levels. Secondary endpoints will include changes from baseline in treatment adherence and inhaler technique scores, Asthma Control Test scores, Mini Asthma Quality of Life Questionnaire scores, lung function parameters, FeNO category distribution, exacerbation rates, short-acting β2-agonist use, and patient-reported satisfaction with the SiA®SMARTer platform. Data on adherence and inhaler technique will be continuously collected through the SiA^®SMARTer platform, and adverse events will be monitored.</p><p><strong>Discussion: </strong>This study may offer valuable insights into whether a digital platform can enhance adherence and inhaler technique, and by that improve asthma control. Additionally, it may help discriminate patients requiring therapy escalation from those with poor control due to non-adherence or incorrect inhaler technique.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06908421, Registration date: 2025-03-26.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403732","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":"Development and multicenter validation of machine learning models for 28-day mortality in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease.","authors":"Jinbin Yang, Tianci Huang, Hongsheng Lu, Junyu Lu, Kaihuan Zhou, Tao Qin","doi":"10.1186/s12890-026-04478-7","DOIUrl":"10.1186/s12890-026-04478-7","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common critical illness in the intensive care unit (ICU) and is associated with poor outcomes. Marked clinical heterogeneity limits the ability of conventional scoring systems to achieve accurate early mortality risk stratification. This study aimed to develop and validate machine learning (ML) models for early prediction of 28-day mortality in critically ill patients with AECOPD.</p><p><strong>Methods: </strong>In this multicentre retrospective study, ML models were developed using the Medical Information Mart for Intensive Care IV database and externally validated in the eICU Collaborative Research Database. Adult patients with AECOPD undergoing first ICU admission were included, and routinely available clinical variables within the first 24 h after ICU admission were extracted. Least absolute shrinkage and selection operator regression was used for feature selection, and nine ML models were developed. Model performance was assessed in terms of discrimination, precision-recall performance, calibration, and clinical utility, and compared with conventional clinical scores. Class weighting was used in the primary analysis, while SMOTE and additional sensitivity analyses were performed to assess robustness.</p><p><strong>Results: </strong>A total of 715 patients were included, of whom 84 (11.7%) died within 28 days. LASSO selected 15 predictive variables. In the internal test set, support vector machine achieved the highest AUC of 0.722. In the external validation cohort, LightGBM achieved the highest AUC of 0.764 and F1 score, GBM showed the highest sensitivity, XGBoost achieved the highest negative predictive value and balanced accuracy, and random forest achieved the highest PR-AUC. Calibration performance varied across models and datasets. Compared with conventional clinical scores, several ML models showed more favourable numerical performance, although no single model consistently outperformed the others across all evaluation dimensions. Sensitivity analyses suggested that the main conclusions were broadly robust.</p><p><strong>Conclusions: </strong>ML models based on routinely available ICU data showed exploratory potential for 28-day mortality risk stratification in critically ill patients with AECOPD. Given the limited number of death events, class imbalance, and risk of overfitting, these findings should be interpreted cautiously. The models are not ready for clinical implementation and require further prospective validation, local recalibration, and evaluation within real-world clinical workflows.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403713","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":"Geographical, institutional and workplace variability in genetic evaluation, screening practices, multidisciplinary care, and lung transplantation management for familial interstitial lung disease.","authors":"Emil Vilstrup Moen, Thomas Prior, Michael Kreuter, Wim A Wuyts, Maria Molina-Molina, Marlies Wijsenbeek, Janne Møller, Sissel Kronborg-White, Nanna Makholm Østergård, Antonió Morais, Argyrios Tzouvelekis, Christopher J Ryerson, Fabian Caro, Ivette Buendia, Jesper Magnusson, Joyce S Lee, Julie Morisett, Justin M Oldham, Lauren K Troy, Manuela Funke-Chambour, Maria Laura Alberti, Raphael Borie, Simon L F Walsh, Sujeet Rajan, Yasuhiro Kondoh, Yet H Khor, Elisabeth Bendstrup","doi":"10.1186/s12890-026-04471-0","DOIUrl":"10.1186/s12890-026-04471-0","url":null,"abstract":"<p><strong>Background: </strong>Advances in genetics have improved the understanding of risk factors for interstitial lung diseases (ILDs). However, geographical and institutional differences in genetic evaluation may affect clinical practice. We aimed to investigate how such variability influences access to genetic testing and screening, awareness of telomerase mutation-related symptoms, and the management of lung transplantation in familial ILD.</p><p><strong>Methods: </strong>An expert panel of pulmonologists working in the field of ILD developed an international survey targeting pulmonologists involved in ILD care. The survey comprised 74 questions addressing diagnosis, screening, genetic testing methods, lung transplantation, and future research needs in familial ILD.</p><p><strong>Results: </strong>In total, 237 pulmonologists representing 50 countries participated in the survey. Respondents from Europe, Oceania, and North America reported significant better access to genetic testing compared to the other continents. European respondents more often had a standardized screening program for first degree relatives than respondents from other continents. Having access to genetic testing significantly increased the likelihood of asking for a family history of early gray hair, liver cirrhosis, and bone marrow disease if a family history of ILD was present and in patients with idiopathic ILD younger than 50 years. Respondents from academic centers were significantly more likely than those from ILD centers to consider telomere length below the 10th percentile as a contraindication for lung transplantation. Respondents from non-academic centers were significantly less likely to treat patients with antifibrotic therapy compared to respondents from academic and ILD centers.</p><p><strong>Conclusion: </strong>This study demonstrated significant differences in access to genetic testing, screening and genetic multidisciplinary teams as well as differences in the management of lung transplantation and antifibrotic therapy in familial ILD. These findings highlight the need for international collaboration to develop evidence-based guidelines for the management of familial ILD.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395908","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":"Characterization of mucus plugging in patients with chronic obstructive pulmonary disease: additional clinical significance of asthma-like features.","authors":"Kaoruko Shimizu, Naoya Tanabe, Susumu Sato, Shotaro Chubachi, Kazuya Tanimura, Naoya Fujino, Hiroaki Iijima, Nobuyasu Wakazono, Isao Yokota, Yuki Abe, Keisuke Kamada, Sho Nakakubo, Hirokazu Kimura, Houman Goudarzi, Takeshi Hattori, Ichizo Tsujino, Hironi Makita, Masaharu Nishimura, Satoshi Konno","doi":"10.1186/s12890-026-04472-z","DOIUrl":"10.1186/s12890-026-04472-z","url":null,"abstract":"<p><strong>Background: </strong>Asthma-like features, defined as a high blood eosinophil count (BEC), atopy, and bronchodilator reversibility, characterize patients with chronic obstructive pulmonary disease (COPD) under optimal treatment. However, whether these features contribute to the phenotype of mucus plugging has not been elucidated. In this study, we aimed to examine the functional and clinical outcomes related to mucus plugging in patients with and without asthma-like features.</p><p><strong>Methods: </strong>Mucus plug score was assessed using inspiratory computed tomography (CT) scans in participants from the Hokkaido COPD cohort study who underwent CT examinations using the same protocol, were categorized based on asthma-like features, and completed the St. George's Respiratory Questionnaire (SGRQ). To evaluate the association between mucus plug score and pulmonary function indices, multivariate analyses were performed to examine the relationships between the mucus plug score and percent predicted forced expiratory volume in 1 s (%FEV₁) or residual volume (RV)/total lung capacity (TLC). These analyses were adjusted for BEC or CT-derived airway indices (total airway wall volume, functional small airway disease, and emphysema index) based on asthma-like feature categorization, in addition to univariate analyses.</p><p><strong>Results: </strong>The mucus plug score was negatively associated with %FEV₁ and FEV₁/forced vital capacity in patients with (N = 45) and without (N = 46) asthma-like features and was positively associated with RV/TLC in those without asthma-like features. As the mucus plug score increased, the SGRQ score worsened in both groups. Multivariate analysis revealed a correlation between mucus plug score and RV/TLC (estimate [95% confidence interval], 1.27 [0.30, 2.25]), but not %FEV_1, in patients without asthma-like features, and between mucus plug score and %FEV₁ (- 1.26 [- 2.33, - 0.20]), but not RV/TLC, in patients with asthma-like features, after adjusting for proximal airway, small airway, and emphysema indices.</p><p><strong>Conclusions: </strong>Asthma-like features may differentiate the functional role of mucus plugging observed on CT scans in patients with COPD. Further studies are needed to validate these findings and clarify the underlying pathophysiology for improved disease management.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395882","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":"A novel percutaneous aspiration sclerotherapy for staged volume reduction of giant single bulla in the treatment of COPD combined with pulmonary bullae.","authors":"Wusheng Deng, Chao Li, Yun Jiang, Xiao Hu, Yufei Jiang, Gang Jiang, Yanjun Hu, Cheng Li, Hui Zhang, Jiazhou Yu, Yongliang Jiang","doi":"10.1186/s12890-026-04429-2","DOIUrl":"10.1186/s12890-026-04429-2","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of a novel technique-percutaneous aspiration sclerotherapy for staged volume reduction of giant single bulla-in patients with chronic obstructive pulmonary disease (COPD) combined with pulmonary bullae remains unclear.</p><p><strong>Methods: </strong>A retrospective study was conducted on 40 COPD patients with pulmonary bullae who underwent the novel percutaneous aspiration sclerotherapy for staged volume reduction of giant single bulla technique. Pulmonary bullae size, pulmonary function, blood gas analysis, six-minute walk test (6MWT), modified Medical Research Council (mMRC) score and St. George 's Respiratory Questionnaire (SGRQ) were assessed before and after the procedure. Related complications were also recorded.</p><p><strong>Results: </strong>The average size of the giant bullae in the 40 patients was 12.67 ± 2.49 cm. Compared with preoperative data, PaO₂, forced expiratory volume in one second (FEV1), FEV1%, forced vital capacity (FVC), FVC%, 6MWT, mMRC score, and SGRQ score were all significantly improved in 40 patients after surgery (p < 0.001); The diameter of the pulmonary bullae was significantly smaller after surgery (p < 0.001); PaCO₂ decreased postoperatively, but no statistical significance (p > 0.05); Pneumothorax was detected in 14 patients. Twelve patients with hemoptysis had small amounts of hemoptysis; eight patients had a fever, and nine patients experienced chest pain.</p><p><strong>Conclusion: </strong>Percutaneous aspiration sclerotherapy for staged volume reduction of giant single bulla is a feasible treatment for pulmonary bullae, involving a straightforward procedure. Nevertheless, its long-term clinical efficacy remains to be further validated in follow-up studies.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395899","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":"Factors associated with delayed diagnosis of fibrotic interstitial lung disease: a retrospective cohort study.","authors":"Hyun J Kim, Surbhi Shah, Sharashchandra Shetty, Pratik Pimple, Ashwin Rai, Charlotte Petterson, Christian Lloyd, Ivana A Vaughn, Lois Lamerato, Wesley Hicks, Amy Olson, Ariel Berger","doi":"10.1186/s12890-026-04420-x","DOIUrl":"10.1186/s12890-026-04420-x","url":null,"abstract":"<p><strong>Background: </strong>Timely diagnosis and treatment of fibrotic interstitial lung disease (ILD) is crucial to preserve lung function and limit healthcare costs. However, diagnosis is challenging and thus often delayed. Factors associated with delayed diagnosis of fibrotic ILD are poorly understood. This study assessed time to diagnosis among patients with fibrotic ILD and identified factors associated with diagnostic delay.</p><p><strong>Methods: </strong>This retrospective cohort study used previously developed algorithms to identify patients from a large integrated tertiary-care health system in the US Midwest with evidence of fibrotic ILD in 2011-2019. Adults identified by these algorithms had their ILD diagnosis and symptom onset date confirmed by chart review. Time from symptom onset to diagnosis was dichotomized as ≤ 6 and > 6 months to assign patients to timely and delayed diagnosis cohorts, respectively. Potential predictors of diagnostic delay (demographics, clinical characteristics, ILD-related symptoms and tests, healthcare use, and healthcare costs) were analyzed by stepwise backward logistic regression and by machine learning using gradient boosting, with the latter illustrated using SHAP (SHapley Additive exPlanations) plots.</p><p><strong>Results: </strong>239 patients met all selection criteria; 138 (57.7%) experienced delayed diagnosis and 101 (42.3%) timely diagnosis. Mean time from symptom onset to diagnosis was 16.8 months for the overall sample, 27.5 months for patients with delayed diagnosis, and 2.2 months for patients with timely diagnosis. Compared to patients with timely diagnosis, greater proportions of those with delayed diagnosis were female (55.8% vs. 40.2%, p = 0.013) and had gastroesophageal reflux disease (GERD) (47.1% vs. 21.6%, p < 0.001) or rheumatic disease (21.0% vs. 10.9%, p = 0.038). In multivariate logistic regression, GERD (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.39-5.04) and number of complaints of cough (OR 1.09, 95% CI 1.02-1.15) and shortness of breath (OR 1.06, 95% CI 1.02-1.09) were associated with increased odds of delayed diagnosis. SHAP plots yielded similar findings.</p><p><strong>Conclusions: </strong>Delays in diagnosing fibrotic ILD are common and on average postpone clinical identification by about 2 years from symptom onset. Factors associated with delayed diagnosis include GERD and repeated complaints of cough/shortness of breath. Further research should explore how delayed diagnosis affects clinical outcomes.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395856","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 GLP-1RA on blood eosinophil levels in adults: a real-world study.","authors":"Yiting Wu, Yi Lin, Jifei Wu, Lei Zhao, Yanmei Lin, Wenwen Chen, Yufan Zhu, Yufan Wang, Min Zhang, Wuping Bao","doi":"10.1186/s12890-026-04469-8","DOIUrl":"10.1186/s12890-026-04469-8","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for glycemic control and weight management, especially semaglutide. Potential benefits of GLP-1RAs in asthma, especially in eosinophilic phenotypes, prompt growing scientific interest.</p><p><strong>Objective: </strong>To investigate the impact of semaglutide on eosinophilic inflammation and to identify clinical and metabolic determinants of eosinophil reduction after treatment.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study in Shanghai, China. Eligible subjects were those first prescribed semaglutide in our outpatient clinic. Demographic characteristics, complete blood counts, and lipid profiles before and after semaglutide treatment were collected from electronic medical records. Subgroup analyses were stratified using a blood eosinophil count (BEC) cut-off of 150/µL and a BMI threshold of 28 kg/m². Multiple linear regression analysis was employed to identify factors influencing the reduction in eosinophil counts.</p><p><strong>Results: </strong>Among 371 participants included in the final analysis, BEC decreased significantly from 160(150)/µL at baseline to 110(100)/µL after semaglutide treatment (P < 0.001), and eosinophil percentage declined from 2.20(1.80)% to 1.60(1.40)% (P < 0.001). The proportion of individuals with eosinophil counts < 150/µL increased from 44.20% to 65.79%. Eosinophil reduction occurred in both baseline eosinophil < 150/µL and eosinophil ≥ 150/µL groups. The percentage reduction in eosinophil count was greater in the BMI-low group than in the BMI-high group (- 31.58% vs. -21.04%, P = 0.037). Multiple linear regression identified baseline eosinophil count as the only independent predictor of eosinophil reduction after treatment.</p><p><strong>Conclusions: </strong>GLP-1RA, semaglutide treatment significantly reduced BECs regardless of baseline levels, with a more pronounced effect observed in non-obese individuals. Higher baseline eosinophil levels independently predicted greater treatment-induced reductions after adjustment for BMI and lipid parameters.</p><p><strong>Trial registration: </strong>ChiCTR2500110394, www.chictr.org.cn . Registration Date, June 20th, 2025.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387402","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":"Combined indwelling pleural catheter with thoracoscopic talc poudrage for malignant pleural effusion management: a randomized non-inferiority trial.","authors":"Jitanong Sootlek, Nophol Leelayuwatanakul, Virissorn Wongsrichanalai, Thitiwat Sriprasart, Vorawut Thanthitaweewat","doi":"10.1186/s12890-026-04463-0","DOIUrl":"10.1186/s12890-026-04463-0","url":null,"abstract":"<p><strong>Background: </strong>Malignant pleural effusion (MPE) causes debilitating dyspnea, severely impacting quality of life (QoL) among patients with advanced stage cancer. While talc pleurodesis effectively prevents recurrence, it requires lengthy hospital stays. Indwelling pleural catheters (IPC) offer outpatient management but are associated with slightly lower pleurodesis success rates and prolonged catheter presence. Given hospital capacity constraints, we evaluated the efficacy of combined thoracoscopic talc poudrage (TTP) and IPC versus TTP alone for symptomatic MPE.</p><p><strong>Methods: </strong>This randomized, non-inferiority-controlled trial, conducted at King Chulalongkorn Memorial Hospital, randomly assigned 38 patients to receive either combined TTP + IPC or TTP alone. The primary outcome was 12-week pleurodesis success rate with a pre-specified non-inferiority margin of - 20%. Secondary outcomes included hospital length of stay (LOS), symptoms control, and QoL. The trial was registered with the Thai Clinical Trials Registry under the registration number TCTR20230312001 (retrospectively).</p><p><strong>Results: </strong>Thirty-eight patients (19 per group) completed the study. Baseline characteristics were comparable, except for significantly worse dyspnea, chest tightness, and QoL scores in the TTP + IPC group. Successful 12-week pleurodesis was 89.5% for TTP + IPC versus 68.4% for TTP alone (difference 21.1%; 95% CI, - 4.0% to 46.1%), establishing non-inferiority as the lower bound exceeded the - 20% margin. The TTP + IPC group demonstrated a significantly greater reduction in dyspnea scores (- 6.39 vs. - 3.67, p < 0.001) and shorter median hospital LOS (1 vs. 4 days, p < 0.001). After adjusting for baseline imbalances (ANCOVA), dyspnea improvement at 6 weeks and EQ-5D-5 L utility scores at 12 weeks remained significant, whereas the VAS QoL difference was attenuated. Complication rates did not differ significantly between groups.</p><p><strong>Conclusion: </strong>TTP + IPC demonstrated non-inferiority to TTP alone regarding 12-week pleurodesis success, thereby preserving pleurodesis efficacy. Furthermore, the combined approach was associated with shorter hospitalizations and improvements in symptom burden; baseline-adjusted analyses confirmed robustness of some but not all patient-reported benefits.</p><p><strong>Trial registration: </strong>TCTR20230312001.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381521","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}