Chest最新文献

{"title":"Dyspnea during resting breathing and carbon dioxide rebreathing in adult patients with congenital central hypoventilation syndrome.","authors":"Marlène Bret, Pierantonio Laveneziana, Marie-Cécile Niérat, Sophie Lavault, Maxime Patout, Inès Zaien, Marion Teulier, Clara Bianquis, Christian Straus, Capucine Morélot-Panzini, Thomas Similowski","doi":"10.1016/j.chest.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.015","url":null,"abstract":"<p><strong>Background: </strong>Congenital central hypoventilation syndrome (CCHS) is an ultra-rare genetic disorder caused by PHOX2B mutations. Patients lack central CO2 chemosensitivity and require ventilatory support during sleep. Children with CCHS have been reported to lack CO2-induced air hunger, but respiratory sensations and dyspnea have not been characterized in adults.</p><p><strong>Research question: </strong>Do genetically characterized adult CCHS patients experience respiratory sensations and dyspnea during unassisted resting breathing and CO2 rebreathing, and along which dimensions?</p><p><strong>Study design and methods: </strong>This was a prospective controlled observational study conducted on a convenience sample derived from a national cohort of an ultrarare disease. Thirteen adult CCHS patients carrying PHOX2B mutations underwent Multidimensional Dyspnea Profile (MDP) assessment during unassisted resting breathing and at the end of CO2 rebreathing. Healthy controls were studied under the same conditions.</p><p><strong>Results: </strong>Before the study, none of the patients had spontaneously reported dyspnea or bothersome respiratory sensations. When prompted with the MDP during resting breathing, 9/13 patients described breathing unpleasantness (non-zero MDP-A1) versus 0/18 controls (p < 0.0001), and 12/13 fulfilled criteria for dyspnea defined as breathing awareness associated with negative affect. During CO2 rebreathing, ventilatory responses remained profoundly blunted, yet breathing unpleasantness increased. Compared with controls, patients had lower sensory and affective ratings, with less frequent air hunger (p = 0.0108). MDP ratings did not correlate with ventilatory response to CO2 or genotype.</p><p><strong>Interpretation: </strong>Adult CCHS patients can experience conscious unpleasant breathing awareness at rest and retain a perceptual response to CO2 despite abolished or nearly abolished central chemosensitivity. These findings suggest respiratory interoceptive pathways beyond canonical brainstem chemosensitive circuits and support active multidimensional assessment of dyspnea in adult CCHS patients.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility, pregnancy, and women's health in bronchiectasis: a multicenter study and ELF-EMBARC patient survey.","authors":"Liora Boehm-Cohen, Jennifer Pollock, Eliza Kompatsiari, Zeev Blumenfeld, Yael Raviv, Rachael McGill, Michael Kassirer, Jeanette Boyd, Lior Elraz, Donna Heilweil, Letizia Traversi, Eva Polverino, Anu Kuusisto, Oriol Sibila, Felix C Ringshausen, Jessica Rademacher, Pieter Goeminne, Peter G Middleton, Ori Wand, Natalie Lorent, Moshe Heching, Rottem Kuint, Henny Azmanov, Andrea Gramegna, Francesco Blasi, Malena Cohen Cymberknoh, Stefano Aliberti, Nili Stein, James D Chalmers, Michal Shteinberg","doi":"10.1016/j.chest.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.010","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis in women of reproductive age is increasingly recognized, yet data on fertility and pregnancy outcomes remain limited.</p><p><strong>Research question: </strong>What are fertility characteristics, pregnancy outcomes, and patient-reported reproductive health experiences in women with bronchiectasis?</p><p><strong>Study design and methods: </strong>We conducted a multicenter, retrospective cohort study across EMBARC-affiliated centers including women with bronchiectasis and pregnancy between 2012 and 2023. Clinical, pulmonary, obstetric, and neonatal data were collected. In parallel, an international patient survey assessed fertility, pregnancy, and hormonal influences on disease. Statistical analyses included comparative and correlation testing.</p><p><strong>Results: </strong>Eighty-three women contributed data from 121 pregnancies and 123 neonates. Mean age at conception was 29.5 years. Assisted reproductive technologies were used in 32.1% of pregnancies, more frequently in primary ciliary dyskinesia (PCD) than other etiologies (48.5% vs. 8.7%, P=0.004). Lung function remained stable during and after pregnancy. Exacerbations occurred in 58.6% of pregnancies. Mean gestational age was 38 weeks and mean birth weight was 2.99 kg. Pre-pregnancy FEV1 correlated with birth weight (ρ=0.42, P=0.001) and gestational age (ρ=0.25, P=0.042). Neonatal outcomes were generally favorable. Survey data (n=629) demonstrated an early onset of menopause in women with bronchiectasis diagnosed before age 50 years compared to after 50 years. Women with PCD reported difficulties conceiving more often than women with early onset bronchiectasis without PCD.</p><p><strong>Interpretation: </strong>Pregnancy in women with bronchiectasis is frequently complicated by exacerbations and low neonatal birth weight. Subfertility is primarily driven by PCD, while non-PCD bronchiectasis shows rates similar to the general population. Pre-pregnancy lung function is associated with neonatal outcomes, supporting the importance of pulmonary optimization and multidisciplinary care before and during pregnancy.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Striving for Equity in Cystic Fibrosis Research: Perspectives from Black and Hispanic/ Latino(a) Individuals with CF.","authors":"Tijana Milinic, Jackie G Kelley, Sophie M Whikehart, Ananya Anand, Sierra C Knapp, William Brandon, Grant A Turner, DeeAnna Serna, Noah Lechtzin, Maria G Tupayachi Ortiz, Siddhartha G Kapnadak, Jordan M Dunitz, Milene T Saavedra, Jennifer L Taylor-Cousar, Crystal E Brown, Christopher H Goss, Kathleen J Ramos","doi":"10.1016/j.chest.2026.09.107","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.107","url":null,"abstract":"<p><strong>Background: </strong>Black and Hispanic people with cystic fibrosis (PwCF) experience worse health outcomes. Health disparities are exacerbated by clinical research that does not adequately represent the diversity of the CF population.</p><p><strong>Research questions: </strong>How do Black/African American and Hispanic/Latino(a) PwCF perceive clinical research? What are the barriers and facilitators to participation in research? Are there viable solutions to improve inclusion?</p><p><strong>Study design and methods: </strong>Semi-structured, individual interviews were conducted with PwCF aged ≥18 years who identify as Black/African American race and/or Hispanic/Latino(a) ethnicity. Participants were recruited from six geographically diverse CF centers and through CF Foundation Community Voice, a CF community partner organization. The interview guide was created by a committee that included minoritized PwCF, research coordinators, and physician-scientists. Thematic analysis with inductive and deductive coding was used to analyze interview transcripts.</p><p><strong>Results: </strong>Twenty PwCF were interviewed from 2024 to 2025. Drawing from a race-conscious adaptation of the Behavioral Model for Vulnerable Populations, we used domains of predisposing, need-based, and healthcare environment factors, as well as emergent themes relating to information and support needs. Participants discussed barriers to research participation that included narrow eligibility criteria (e.g., genotype requirements, health status) and logistical challenges such as time and cost. PwCF described a sense of isolation as persons of color with CF, which impacted sense of trust in CF care and research studies. They highlighted that racialized experiences, especially doubt surrounding their CF diagnosis, significantly impact willingness to participate. Solutions center around providing community support to address feelings of isolation and information needs to provide transparency about study design and intent.</p><p><strong>Interpretation: </strong>Participation in clinical research is strongly influenced by an interplay of social, cultural, health, and systemic factors. Solutions to improve inclusion in trials center the needs of marginalized communities across all phases of study design and implementation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of clarithromycin on the circulating inflammatory proteome in community-acquired pneumonia: a secondary analysis of the ACCESS trial.","authors":"Emmanouil Stylianakis, Konstantinos Tsiakos, Georgios Niotis, Sarantia Doulou, Lamprini Skorda, Konstantina Iliopoulou, Evangelia-Maria Adami, George Chrysos, Styliani Gerakari, Haralampos Milionis, George Dalekos, Theano Kontopoulou, Vasiliki Tzavara, Karolina Akinosoglou, Styliani Sympardi, Mihai G Netea, Evangelos J Giamarellos-Bourboulis, Vinod Kumar","doi":"10.1016/j.chest.2026.10.012","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.012","url":null,"abstract":"<p><strong>Background: </strong>The ACCESS randomized double-blind controlled trial in hospitalized adults with community-acquired pneumonia (CAP) showed that adding clarithromycin to standard-of-care therapy accelerated clinical recovery within the first 72 hours after the commencement of treatment and reduced progression to organ dysfunction.</p><p><strong>Research question: </strong>Does clarithromycin treatment modulate the circulating inflammatory protein profile in CAP, and can inflammatory endotypes identify patient subgroups with distinct clinical responses?</p><p><strong>Study design and methods: </strong>Serum samples obtained from ACCESS trial patients at baseline and 72 hours were profiled using the Olink Target 96 Inflammation panel. Patients were grouped by treatment arm and by achievement of the trial's composite primary endpoint. After quality control, 70 proteins from 394 paired samples across 197 patients were analyzed to assess differential expression within and between groups over time, evaluate associations with clinical outcomes, and identify immune endotypes using unsupervised clustering.</p><p><strong>Results: </strong>IL6 was selectively downregulated on day 4 in the clarithromycin arm, whereas IFN-γ, CXCL9, CXCL10, and SCF decreased over time across both treatment arms, consistent with resolution of inflammation. Among patients achieving the primary endpoint, IL6, CXCL9, CXCL10, and IFN-γ were suppressed only in clarithromycin-treated individuals. Clustering consistently identified two inflammatory endotypes with comparable SOFA, but distinct RSS scores. The endotype with lower RSS demonstrated higher IFN-γ and globally elevated inflammatory protein expression; in that endotype 90-day mortality was decreased with clarithromycin treatment.</p><p><strong>Interpretation: </strong>Clarithromycin exerts measurable immunomodulatory effects in CAP, characterized by attenuation of pro-inflammatory cytokines, particularly IL6. The identification of distinct inflammatory endotypes suggests biological heterogeneity in CAP and supports future investigation of endotype-guided approaches to identify patients most likely to benefit from immunomodulatory therapies.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov NCT04724044, EudraCT 2020-004452-15.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Cancer Screening Rates Remain Low Among Adults Aged 50-54 Years Despite Updated USPSTF Recommendations.","authors":"Elkhansa Sidahmed, Yuying Xing, Huong N Q Tran, Elie Mulhem, Ramin Homayouni","doi":"10.1016/j.chest.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.011","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Frequency Chest Wall Oscillation in Acute Respiratory Failure With Bronchial Hypersecretion: A Randomized Controlled Trial.","authors":"Simone Ielo, Nicoletta Golfi, Luca Guidelli, Stefania Arniani, Matilde Vespi, Gabriella Tacconelli, Noemi Preziosi, Uberto Maccari, Teresa Renda, Raffaele Scala","doi":"10.1016/j.chest.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.007","url":null,"abstract":"<p><strong>Background: </strong>Airway secretion retention is common in patients with acute respiratory failure (ARF), particularly in those requiring noninvasive respiratory support (NIRS). High-frequency chest wall oscillation (HFCWO) may improve airway clearance but critical care evidence remains limited.</p><p><strong>Research question: </strong>Does adding HFCWO to standard care improve clinical outcomes in patients with bronchial hypersecretion and ARF requiring NIRS?</p><p><strong>Study design and methods: </strong>We conducted a single-center randomized controlled trial in a RICU. Patients with ARF requiring NIRS, including high-flow nasal cannula (HFNC) and/or noninvasive ventilation (NIV), bronchial hypersecretion, and ineffective cough (peak cough expiratory flow <270 L/min) were randomized 1:1 to HFCWO plus standard care or standard care alone. The primary endpoint was therapeutic bronchoscopy. Secondary endpoints included hospital length of stay (LOS), RICU-LOS, NIRS duration, endotracheal intubation and mortality. Outcomes were analyzed using unadjusted and adjusted models accounting for age, sex, and main cause of hospitalization.</p><p><strong>Results: </strong>Eighty-eight patients were enrolled (44 HFCWO, 44 control), with comparable baseline characteristics. Bronchoscopy was required in 6 patients (13.6%) versus 14 (31.8%) (unadjusted p=0.042); after adjustment the association did not retain statistical significance (adjusted OR 0.336, 95% CI 0.111-1.021; p=0.055). Secondary outcomes, analyzed without correction for multiple testing, are exploratory. Hospital stay (12 [10-15.5] vs 16.5 [13-21] days) and RICU stay (8 [7-10.5] vs 12 [9-17] days) were shorter, with adjusted reductions of 4.5 and 3.6 days. HFNC duration was shorter (6 [4-8] vs 9.5 [6-11.5] days) and remained significant after adjustment, whereas the reduction in NIV duration did not (adjusted p=0.166). No patient required intubation and mortality did not differ.</p><p><strong>Interpretation: </strong>In this exploratory trial, HFCWO did not significantly reduce the need for therapeutic bronchoscopy after adjustment. Associated reductions in LOS and HFNC duration are hypothesis-generating and require confirmation in adequately powered multicenter trials.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov: NCT05751707; Tuscany Ethics Committee (Protocol: 21987-10/17/2022).</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dominant lung involvement and heterozygous IFIH1 variants.","authors":"Christina K Rapp, Moritz Herkner, Victoria S E Crippa, Kataryzna Michel, Nurlan Dauletbaev, Ferdinand Guerth, Moniek van de Loo, Niels W Rutjes, Silvia Castillo-Corullón, Nazan Cobanoglu, Petra Kaiser-Labusch, Ulrich M Zissler, Simone Reu-Hofer, Nicolaus Schwerk, Florian Gothe, Matthias Griese","doi":"10.1016/j.chest.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.001","url":null,"abstract":"<p><strong>Background: </strong>Heterozygous gain-of-function (GoF) variants in IFIH1 are associated with rare autoinflammatory diseases characterized by heightened interferons-stimulated gene (ISG) signatures. These include Aicardi-Goutières syndrome, presenting with slowly progressive spastic paraparesis of the lower limbs, intracerebral calcifications, and neuroinflammation, and Singleton-Merten syndrome, defined by tooth loss, bone demineralization, and vascular calcification.</p><p><strong>Research question: </strong>Do rare IFIH1 GoF variants contribute to an interstitial lung disease phenotype, thereby expanding the spectrum of IFIH1-related disorders?</p><p><strong>Study design and methods: </strong>Among 559 children with interstitial lung disease (chILD) and exome sequencing as part of their diagnostic work-up, 12 rare heterozygous IFIH1 variants were identified. Of these, 10 were missense variants of unknown significance, which were functionally assessed in vitro using luciferase assay and ISG-expression profiling. Genome-wide RNA analysis was performed on available patient samples to explore broader transcriptional effects.</p><p><strong>Results: </strong>Four variants with increased basal IFNβ transcription in vitro and elevated ISG expression in vivo indicating GoF behaviour were identified. Disease severity correlated with GoF potential of the respective variant. Two patients harbouring IFIH1 variants with strong GoF activity displayed multisystem involvement and died from respiratory failure at 3 and 4 months of age, respectively. Two additional patients showed milder phenotypes with chronic lung disease stabilizing by the age of 8 and 10 years, respectively. Lung biopsies showed alveolar hypoplasia and alveolar macrophage pneumonia (=desquamative interstitial pneumonia) of varying severity.</p><p><strong>Interpretation: </strong>We report a dominant interstitial lung disease phenotype in individuals harbouring novel IFIH1 variants, expanding IFIH1-related disease to the group of type I interferonopathies with pulmonary manifestations like STING-associated vasculopathy with onset in infancy (SAVI) and COPA syndrome.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Continuous Automatic Endotracheal Cuff Pressure Monitoring in Preventing Ventilator-Associated Pneumonia in the Pediatric Intensive Care Unit: A Randomized Controlled Trial.","authors":"Ayşe Aşık, Muhterem Duyu, Saime Hacer Özdemir Dağhan, Pelin Pehlivan, Burçin Türkmen, Nergiz Alçınkaya Sevinç, Yasemin Tüfekçi, Büşra Özyıldırım, Selin Yıldız Sametoğlu, Yonca Bulut","doi":"10.1016/j.chest.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.chest.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a major healthcare-associated infection in critically ill children, primarily driven by microaspiration around the endotracheal tube cuff.</p><p><strong>Research question: </strong>Does continuous automatic cuff pressure monitoring (CACPM) reduce the incidence of VAP compared to intermittent manual cuff pressure monitoring (IMCPM) in critically ill pediatric patients requiring mechanical ventilation?</p><p><strong>Study design and methods: </strong>In this open-label, randomized controlled superiority trial, pediatric patients requiring mechanical ventilation for ≥48 hours were randomly assigned (1:1) to either CACPM or IMCPM. The target cuff pressure was strictly maintained at 20-25 cmH₂O. The primary outcome was the proportion of patients developing VAP within 28 days following intubation, evaluated in the intention to treat population. Secondary outcomes included time to VAP diagnosis and target pressure compliance. Statistical approaches included Kaplan-Meier survival analysis and multivariable Cox proportional hazard regression.</p><p><strong>Results: </strong>Among 241 randomized patients, ITT analysis showed lower VAP with CACPM than IMCPM (13.3% vs 24.0%; risk difference, -10.6 percentage points; 95% CI, -20.3 to -0.8; P=0.034), with similar PP findings (15.0% vs 26.6%; P=0.044). ITT incidence density was 15.7 vs 27.1 per 1,000 ventilator-days (IRR, 1.73; 95% CI, 0.94-3.18; P=0.080). Unadjusted time-to-VAP was nonsignificant (HR, 1.80; 95% CI, 0.976-3.321; P=0.060), whereas adjusted Cox analysis narrowly indicated a higher VAP hazard with IMCPM (HR, 1.90; 95% CI, 1.024-3.510; P=0.042). Target-pressure compliance was higher with CACPM (P<0.001).</p><p><strong>Interpretation: </strong>CACPM significantly reduces the proportion of critically ill pediatric patients developing VAP compared with IMCPM. This preventive effect appears directly linked to improved target pressure compliance, suggesting that automated regulation could be a valuable addition to pediatric VAP prevention strategies.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT05918172.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switching from mepolizumab to benralizumab in eosinophilic granulomatosis with polyangiitis (EGPA).","authors":"Adrien Cottu, Irene Mattioli, Matthieu Groh, Xavier Puéchal, Allyson Egan, Roberto Padoan, Luisa Brussino, Jan Schroeder, Camille Taillé, Maxime Samson, Pascal Cathébras, Francesco Cinetto, Halil Yildiz, Gregory Pugnet, Pierre Chauvin, Stéphane Jouneau, Elisabeth Diot, Sarah Nicolas, François Lifermann, Jean-Philippe Martellosio, Laurent Guilleminault, Yann Nguyen, Claire De Moreuil, Philippe Guilpain, Vincent Cottin, Luca Moroni, Paolo Delvino, Franco Franceschini, Edoardo Conticini, Claudia Crimi, Gianluca Moroncini, Milena Bond, Laura Moi, David Jayne, Augusto Vaglio, Colas Tcherakian, Giacomo Emmi, Benjamin Terrier","doi":"10.1016/j.chest.2026.08.058","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.058","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic granulomatosis with polyangiitis (EGPA) is an ANCA-associated vasculitis characterized by eosinophilic asthma and ENT involvement. Both mepolizumab and benralizumab have demonstrated efficacy in EGPA and are now considered front-line options. In patients who do not respond to mepolizumab, benralizumab may be a valuable alternative owing to its enhanced depletion of eosinophils. We assessed the efficacy for and safety of switching from mepolizumab to benralizumab in EGPA.</p><p><strong>Research question: </strong>Is benralizumab effective and safe in EGPA patients after mepolizumab failure, given its enhanced depletion of eosinophil?</p><p><strong>Study design and methods: </strong>We conducted a retrospective European multicenter study including 68 adult EGPA patients who received benralizumab after mepolizumab failure. Complete (CR) and partial (PR) response were defined as BVAS=0, with prednisone ≤4 mg/day and > 4 mg/day, respectively.</p><p><strong>Results: </strong>Median benralizumab follow-up period was 28 [20-39] months. CR and PR were achieved in 32% and 25% of patients, and maintained at last follow-up in 19% and 16%. Median time to CR was 6 [4-12] months. Forced expiratory volume in one second improved from 73% to 79%, and 38% of patients discontinued glucocorticoids. Vasculitis flares occurred in six patients. Primary mepolizumab failure was associated with lower CR rates (OR 0.19, 95% CI 0.06-0.60). Benralizumab was discontinued in 18% due to persistent respiratory symptoms. Adverse events occurred in five patients, including two severe SARS-CoV-2 infections.</p><p><strong>Interpretation: </strong>In EGPA patients with persistent respiratory manifestations after mepolizumab failure, switching to benralizumab could represent a valuable option, improving lung function and reducing glucocorticoid use. Further prospective studies are needed to optimize sequencing and patient selection.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in small airway function following Dupilumab initiation for type 2 COPD - a prospective multicenter study.","authors":"Ophir Freund, Frederik Trinkmann, Shahar Koppelman, Konstantina Kontogianni, Inbar Yacoby Halevi, Doron Cohn-Schwartz, Nimrod Urtreger, Ariel Malloul, Eyal Kleinhendler, Amir Bar-Shai","doi":"10.1016/j.chest.2026.09.099","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.099","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}