Preserved Lung Function Research Articles

Clinical Remission by a Comprehensive Severe Asthma Management Strategy Guided by Airway Inflammometry and Bioimaging.

Rationale: Clinical remission is a multicomponent treatment goal in severe asthma. However, only about 30% of patients achieve clinical remission when treatment decisions are guided using blood eosinophil and FeNO levels. Objectives: To assess the effectiveness of a comprehensive, individualized treatment strategy in achieving clinical remission over 24 months in patients with severe asthma. Methods: Treatment strategies-including anti-inflammatory therapies, biologics, antibiotics, immunomodulators, and bronchial thermoplasty-were guided by clinical assessment, airway physiology, airway inflammometry, and bioimaging. Clinical remission was defined as no exacerbations for 24 months, no oral corticosteroid (OCS) use, and partly/well-controlled symptoms, with or without lung function criteria. Measurements and Main Results: One-hundred seventy-eight patients with severe asthma were evaluated. Of these, 88.2% were treated with biologics alone or in combination with other strategies; 20.2% were treated with antibiotics, hypertonic saline, and/or immunoglobulins; and 9% underwent bronchial thermoplasty after controlling the inflammatory component. After 24 months, 89.9% of patients were exacerbation-free, 83.1% were OCS-free, 78.1% had partly/well-controlled symptoms, and 84.8% had preserved lung function. Clinical remission was achieved in 66.3% of patients based on the three primary criteria and in 61.6% when including FEV1% decline ≤5% from baseline. However, when the most stringent criteria were applied (ACQ-5 ≤0.75 and FEV1 ≥80%), the clinical remission rate was 29.1%. Residual disease activity was driven primarily by airway infections and airway hyperresponsiveness rather than T2 inflammation. Conclusions: By using a comprehensive set of biomarkers and employing a management strategy tailored to individual pathobiology, a high proportion of patients with severe asthma can achieve clinical remission, depending on the definitions used. Nonetheless, recurrent airway infections, mucus, and airway hyperresponsiveness remain key unmet needs in severe asthma.

Impact of Spread Through Air Spaces (STAS) on Recurrence and Surgical Trends in Stage I Non-Small Cell Lung Cancer: A Real-World Cohort Study.

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, which remains a leading cause of cancer mortality worldwide. Early detection, particularly at Stage I, is critical for improving survival outcomes. Low-dose computed tomography (LDCT) has increased the detection of small asymptomatic tumors, resulting in an earlier diagnosis and facilitating less invasive surgical approaches such as segmentectomy and wedge resection, which preserve lung function while offering survival outcomes comparable to lobectomy. However, the risk factors for recurrence in Stage I NSCLC remain poorly understood. This retrospective study analyzed 1077 Stage I NSCLC patients treated at Kaohsiung Medical University Hospital from 2010 to 2022. Data including AJCC 7th and 8th editions staging, surgical interventions, and pathological features were analyzed. The proportion of Stage I cases increased significantly from 9.3% in 2010 to 33.8% in 2017, with Stage IA cases increasing from 12.1% in 2018 to 38.2% in 2022. Concurrently, the lobectomy rate decreased from 75% in 2010 to 43.6% in 2022, with more sublobar resections performed. Kaplan-Meier analysis found no significant differences in recurrence-free survival between lobectomy and sublobar resection with regional lymph node dissection. Cox regression identified spread through air spaces (STAS) as an independent risk factor for recurrence (hazard ratio 2.87, p = 0.006), along with male sex, larger tumor size, and visceral pleural invasion. These findings highlight the role of LDCT in early detection and the importance of tailored treatment strategies, particularly addressing STAS, to optimize recurrence-free survival and improve outcomes of patients with Stage I NSCLC.

The case of a patient with Mounier-Kun syndrome

Mounier-Kuhn syndrome (MKS) is a rare disease characterized by significant enlargement of tracheobronchial tree, recurrent cough and lower respiratory tract infections. Condition is typically diagnosed through imaging techniques such as computed tomography (CT) scans of the chest and bronchoscopy as well. There are asymptomatic or symptomatic cases in the disease while symptoms can be varied from minimal with preserved lung function to severe, including respiratory failure with recurrent pneumonia and bronchiectasis. Therapy is mainly symptomatic and aimed to manage symptoms. Surgery rarely has a place in the treatment of MKS. Although in the world literature reports of surgical interventions in some patients with MKS surgery have been presented, this type of treatment has not been widely adopted. Due to the lack of specific features in the clinical presentation of the condition, it should be taken into consideration in patients with recurrent episodes of pneumonia and frequent exacerbations of chronic bronchitis. This particular case is presented the patient with non-specific symptoms in the form of a non-productive cough and recurrent episodes of suffocation attacks. To evaluate the patient’s condition, CT of the chest and bronchoscopy are performed. These tests revealed tracheobronchomegaly and tracheal diverticula, which are both associated with the condition.

Asthma remission: A path to cure?

Asthma is a chronic inflammatory airway disease characterized by variable respiratory symptoms and reversible airflow limitation. Despite significant advances in pharmacologic and immunotherapeutic treatment, definitive remission or cure remains elusive. Asthma remission is defined as a sustained absence of symptoms, exacerbations, and lung function decline, with or without ongoing therapy. In contrast, an asthma cure implies permanent disease eradication marked by lifelong symptom resolution, no need for maintenance or rescue medication, preserved lung function, and absence of airway inflammation. To date, no intervention has been proven to cure asthma. Consequently, clinical remission has emerged as a more achievable and meaningful goal in asthma management. This review summarizes recent findings on remission rates, key factors influencing asthma remission, and the impact of various therapeutic strategies-including immunotherapy and advanced biologics. We also highlight evidence underscoring the foundational role of comprehensive asthma care. Asthma should be managed within the context of a unified allergic airway disease; thus, systematic identification and treatment of coexisting conditions such as allergic rhinitis and rhinosinusitis, nasal polyps is essential, as they often exacerbate lower airway symptoms. Routine nasal irrigation, environmental control measures, and attention to modifiable lifestyle factors-such as sleep hygiene, physical activity, and weight management-are critical. When consistently implemented, these holistic approaches may significantly improve disease control and support the achievement of clinical remission. Achieving a cure for asthma remains the ultimate goal, necessitating a long-term commitment and strategically designed basic and clinical research to determine its viability.

Patients’ and Health Care Professionals’ Perspectives on Remote Patient Monitoring in Chronic Obstructive Pulmonary Disease Exacerbation Management: Initiating Cocreation

BackgroundChronic obstructive pulmonary disease (COPD) exacerbations cause physiological and psychological distress, affecting overall health and quality of life. Early diagnosis of exacerbations is crucial for preserving lung function, preventing hospitalizations, and reducing health care costs. While remote patient monitoring (RPM) offers the potential for early exacerbation detection, challenges remain in recognizing symptoms in a timely manner. A noninvasive breath analysis device is under development to monitor patients with COPD and detect exacerbations before symptoms arise by measuring breath biomarkers through volatile organic compounds. This study encompassed the initial cocreation phase to align the use of the breath analysis device and corresponding care process with current COPD exacerbation management and user needs.ObjectiveWe aimed to explore perspectives on COPD care processes, exacerbation management, and RPM in the Netherlands through 3 objectives: (1) identify stakeholders in COPD exacerbation care, (2) understand existing COPD care, and (3) explore stakeholder experiences and expectations regarding RPM in COPD care.MethodsFollowing the Center for eHealth Research and Disease Management Roadmap, 4 research activities were conducted between March 2024 and September 2024 for the initial cocreation phase: (1) desk research, (2) interviews, (3) project group meeting, and 4) coanalysis focus group. Desk research involved reviewing literature and COPD (exacerbation) care guidelines. Semistructured interviews (N=34) were conducted with 18 patients, 14 health care professionals (HCPs), 1 caregiver, and 1 hospital policy adviser. Topics included COPD diagnosis, exacerbation management, stakeholder roles in COPD care, and RPM experiences or expectations. The project group meeting between interviews and the focus group verified interim findings and guided the focus group content. In total, 6 patients participated in a coanalysis focus group to review interview quotes on exacerbations and RPM. The framework method was used to analyze the interviews and the focus group through abductive coding.ResultsSeven key stakeholders were identified in COPD care, patients, pulmonologists, general practitioners, nurse practitioners, nurse specialists, physiotherapists, and informal caregivers. We observed a lack of uniformity in COPD care, exacerbation management, and information provision across HCPs. Patients reported struggling to recognize exacerbations. Although patients with experience in RPM reported positive experiences, they questioned the added value in early detection of exacerbations. Those without RPM experience were receptive to its use for symptom tracking but were concerned about reduced in-person care and overreliance on data. HCPs reported seeing value in RPM for between-visit monitoring and efficiently allocating resources but stressed the need for clear guidelines and noted barriers, such as language proficiency and technology usability.ConclusionsThis study highlights the opportunities to improve COPD care and optimize exacerbation management with RPM. Future research should refine RPM processes, balance objective data with patient-reported symptoms, enhance communication among HCPs and with patients, provide clear exacerbation management guidelines, and ensure inclusivity.

Bronchial rheoplasty for chronic bronchitis: real world evidence of safety and performance

BackgroundBronchial rheoplasty (BR) addresses mucosal inflammation and hypersecretion associated with chronic bronchitis (CB) by ablating goblet cell hyperplasia with non-thermal pulsed electric fields. This study assessed if BR continues to demonstrate a safe profile and symptom burden reduction in CB patients.MethodsThis observational, post-market, single-arm registry was conducted at 8 centers in Austria and Germany. Patients with CB and high symptom burden (COPD assessment test score [CAT] ≥7 points in the first two questions) were treated with two bronchoscopic BR procedures. The primary outcomes were safety and symptom burden at 12 months, evaluated by (serious) adverse events (SAE) and questionnaire scores (CAT and St. George's Respiratory Questionnaire [SGRQ]). Subgroup analyses were performed to identify treatment responders.Results106 BR procedures were performed in 54 patients (mean FEV157.8±25.3%, RV 166.2±39.6%, CAT 24.8±6.8) with a follow-up time up to 12 months (n=40). The procedure could be performed safely, with only 2 SAEs (thoracic pain) and 9 AEs (mainly COPD exacerbation) deemed to be related to the device or procedure over 12 months. Patients experienced statistically significant questionnaire score improvements (CAT −5.5 [±8.0] at 6 months, −4.2 [±7.4] at 12 months) and SGRQ at 6 and 12 months. CAT responders (improvement≥the minimal clinically important difference of 2 points) had more preserved lung function and better exercise capacity at baseline than CAT non-responders.ConclusionThe real-world clinical experience demonstrates that BR is a relatively safe and promising treatment option for CB patients with significant symptom burden.

Exploring the impact of surgical treatment for lung cancer in patients with Airway Obstruction from a Lung Cancer Screening Program.

Little information is available on the surgical treatment options for patients with Airway Obstruction (AO) and early-stage non-small cell lung cancer (NSCLC) followed in lung cancer screening programs (LCS). This study aims to compare the potential impact of anatomical sub lobar resections vs. lobectomies in these patients. This is a retrospective analysis of participants who underwent surgical resections within a Lung Cancer Screening Program, including those with AO (post bronchodilator FEV1/FVC < 0.70). The short-term survival, locoregional recurrence, perioperative complications, and difference between pre and postoperative pulmonary function tests were compared between the surgical groups in those with AO. Anatomical sub lobar resections or lobectomies for Stages IA and IB NSCLC were performed in 133 patients. Out of these, 57 had AO. Anatomical sub lobar resections were non-inferior to lobectomies for short-term survival in patients with AO (3-year survival rate: 95.8% vs. 97%, p = 0.83). In these patients, sub lobar resections had a higher recurrence rate (12.5% vs 0%, p < 0.01). No significant differences were found in postoperative complications between surgical techniques (sub lobar 33% vs lobectomy 24%, p = 0.44). Lastly, no significant difference was found on the change between pre and postoperative FEV1 and DLCO (p = 0.96 and 0.79 for FEV1 and DLCO, respectively). The present retrospective analysis suggests that sub lobar resection might be the best surgical option for treating early-stage NSCLC in patients with AO, where lung function preservation techniques are desired, but requires closer follow up to detect recurrence. Further studies in larger samples should confirm our findings.

Phenotypic Analysis of Pulmonary Hypertension Associated With Low Diffusion Capacity and Preserved Lung Function

Phenotypic Analysis of Pulmonary Hypertension Associated With Low Diffusion Capacity and Preserved Lung Function

Uncomplicated SARS-CoV-2 Infections with Preserved Lung Function in Pediatric Patients with Cystic Fibrosis: A Three-Year Single-Centre Experience.

Background/Objectives: Patients with chronic lung diseases, such as cystic fibrosis, were considered a risk group for a severe course of coronavirus disease 2019 at the beginning of the pandemic. However, mounting evidence suggests that this group may not face an elevated risk for a severe SARS-CoV-2 infection. Methods: Here, we present data on the incidence and clinical course of SARS-CoV-2 infections in a single pediatric CF centre in Austria. Clinical variables were analyzed for their potential impact on disease acquisition and severity. A total of 135 young people with CF were assessed from February 2020 until December 2022. Results: Eighty-four patients were infected with SARS-CoV-2, out of which nine patients reported re-infection, resulting in 93 SARS-CoV-2 infections. Most infections, 76/93 (82%), occurred during the period of omicron variant predominance. Higher body mass index and respiratory colonization with Haemophilus influenzae before the beginning of the pandemic were significantly associated with the risk of acquiring SARS-CoV-2 infection. All patients had an uncomplicated COVID-19 course, regardless of the SARS-CoV-2 variant and COVID-19 vaccine status at infection. The most frequent symptoms were rhinitis (53%), fatigue (49%), cephalea (43%), and fever (38%). Neither oxygen therapy nor hospitalization were needed for any of the patients. Lung function parameters (FEV1, FVC, FEF50, LCI), both in the early post-viral as well as late post-viral stages, were not significantly impacted by SARS-CoV-2 infections. No long-term post-COVID-19 effects were reported. Conclusions: Our single-centre experience suggests that the course of SARS-CoV-2 infections in children and adolescents with CF is primarily mild and uncomplicated.

Kratopenia as an indicator of sarcopenia in smokers: Cut-off points for peak knee torque.

Muscle strength is a crucial predictor of adverse outcomes and is essential for identifying kratopenia and physical limitations. Smoking can aggravate this condition, damaging the musculoskeletal system. Assessing muscle strength, especially with portable dynamometers, is essential for early detection of muscle dysfunction. Studies demonstrate the importance of standardizing protocols and defining cut-off points for peripheral muscle weakness in general. Thus, focusing on the effects of smoking on muscle function, the objective was to investigate cut-off points based on functional limitation and identify the presence of kratopenia in smokers. This cross-sectional study, composed of smokers (conventional cigarettes), regardless of gender, aged over 18 years, was conducted with a comprehensive approach. The volunteers were evaluated by personal data, carbon monoxide analysis (monoximetry), and physical-functional aspects such as lung function (spirometry), functional performance (6-minute walk test, sit-to-stand, fourmeter gate speed, and physical activity in daily life), and peripheral muscle strength (portable digital dynamometry). A total of 143 smokers were evaluated, with high levels of tobacco dependence and preserved lung function. Men showed significantly higher peripheral muscle strength across all variables (p < 0.05). ROC analysis revealed acceptable discrimination for detecting kratopenia from functional limitation: AUC of 70% for knee extension (p < 0.01) from the cut-off points identified for knee extension lower than 214.8Nw and 273.6Nw; and 70% for knee flexion (p < 0.01) lower than 125 Nw and 156.2Nw, women and men, respectively, to be loss of muscle strength and power. Kratopenia was present in > 50% of participants based on peak torque (Nw) (56% of knee extension and 52% of knee flexion), being more prevalent in women. Peak knee torque measurements, especially those of extension and flexion, can determine kratopenia in limited functional smokers. Determining specific cut-off points offers an effective tool to identify and prevent sarcopenia risk in smokers.

COPD Exacerbations and Airflow Obstruction Severity Pre- and Post-Pneumococcal Vaccination: A post hoc Analysis of the RETRIEVE Real-World Study

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. Prevention of exacerbations is fundamental to COPD management. Methods: The RETRIEVE study was a multicenter, 7-year retrospective study (NCT03858348) of patients with spirometry confirmation of COPD, who received LABA/ICS for at least 1 year and either continued or escalated to open triple therapy, according to their physicians’ judgment. In this post hoc analysis, we explored exacerbation rate and lung function pre- and post-pneumococcal vaccination in a real-world setting. Results: Among 466 COPD patients, 48.1% received LABA/ICS for a mean 32 months, while 51.9% received LABA/ICS for a mean 21 months and then escalated to open triple therapy. Patients treated solely with LABA/ICS presented a significant reduction in COPD exacerbations (incidence rate ratio 0.66, 95% confidence interval [0.56, 0.78]) and related hospitalizations (0.43 [0.25, 0.72]) after pneumococcal vaccination compared to pre-vaccination. High-risk patients, who ultimately escalated to triple therapy, presented no reduction in exacerbations post-vaccination compared to pre-vaccination, and their airflow obstruction tended to deteriorate over time post-vaccination while they received LABA/ICS. However, after escalation to open triple therapy, there was significant reduction in exacerbations (0.78 [0.66, 0.94]) and related hospitalizations (0.41 [0.26, 0.66]) post-vaccination compared to pre-vaccination. Pneumococcal vaccination rates increased from 2012 to 2018 in our study, exceeding 90% from 2015 onward. Preserved lung function potentially delayed vaccination. Conclusion: This post hoc analysis of the RETRIEVE real-world study highlights the importance of appropriate, personalized maintenance COPD treatment, along with pneumococcal vaccination, for the prevention of COPD exacerbations.

Early clinical remission and its role in lung function decline and exacerbation in adult Korean patients with asthma

IntroductionDespite advancements in asthma management, many patients continue to experience poor disease control, lung function decline, and frequent exacerbations. Clinical remission (CR) has been proposed as a novel treatment target...

A complex foregut malformation: case report and review

Introduction: Esophageal duplication cysts (EDCs) associated with pulmonary sequestration (PS) are rare congenital anomalies originating from the embryonic foregut. They often present diagnostic challenges due to their complex nature and non-communicating features. Case Report: We report the case of a one-year-old girl with a prenatal diagnosis of a cystic lesion, initially suspected to be congenital cystic adenomatoid malformation. Postnatal imaging confirmed the presence of PS and a non-communicating EDC. Thoracoscopic lobectomy was performed, and histopathology confirmed the diagnosis. Discussion: This case highlights the difficulty in diagnosing non-communicating EDCs with PS, especially prenatally. Imaging techniques like CT and MRI are crucial, but histological analysis remains the gold standard for confirmation. Multidisciplinary management is essential for accurate diagnosis and effective treatment. Conclusion: Early surgical intervention is critical to prevent complications and ensure a favorable outcome. Thoracoscopic surgery offers benefits in terms of morbidity reduction and preservation of lung function.

Low Vitamin K Status and Risk of Chronic Obstructive Pulmonary Disease.

Background: Vitamin K is a cofactor necessary for the biological activity of proteins like Matrix Gla Protein (MGP), which reduce calcification and help preserve lung function. This study aims to determine, first, whether low vitamin K status is associated with chronic obstructive pulmonary disease (COPD), and secondary, whether the level of vitamin K is associated with COPD severity, smoking exposure, or mortality. Methods: The plasma concentration of dephosphorylated uncarboxylated (dp-uc) MGP was used as an inverse biomarker for vitamin K in 98 COPD patients from the CODEX-P COPD study and 986 controls from the DanFunD study. Low vitamin K status was defined as the upper quartile of dp-ucMGP (>589 pmol/L). Using a logistic regression model, we examined whether low vs. high/moderate vitamin K status increased the odds ratio (OR) of having COPD. Secondary analyses, in the COPD cohort only, examined the association between low vitamin K status and COPD severity, smoking exposure in packyears and all-cause mortality, using a Welch's t-test and log-rank test, respectively. Results: Low vitamin K status was associated with increased odds of having COPD, OR 9.7 (95% CI [5.5 to 17.5], p < 0.001). We found no associations between low vitamin K and COPD severity (est. -0.03, p = 0.7; 95% CI [-0.2 to 0.1]), smoking exposure (p = 0.7), or all-cause mortality (p = 0.5). Conclusions: Low vitamin K status was associated with substantially higher odds of having COPD compared to high/moderate vitamin K status. No association was found between low vitamin K status and COPD severity, smoking exposure, or all-cause mortality. Further studies are needed to determine if vitamin K plays a role in the pathophysiology of COPD and whether supplement therapy is indicated.

Segmentectomy Versus Wedge Resection for Stage IA Lung Adenocarcinoma-A Population-Based Study.

Sublobar resection (SLR), including segmentectomy and wedge resection (WR), is an alternative to lobectomy for early-stage lung cancer due to its potential benefits in preserving lung function. However, the comparative outcomes between segmentectomy and WR for stage IA lung adenocarcinoma are equivocal. This population-based study aimed to compare overall survival between segmentectomy and WR. Data on patients with clinical stage IA lung adenocarcinoma were collected from the Taiwan Cancer Registry between 2011 and 2018. The primary endpoint was overall survival. Further subgroup survival analyses were conducted based on tumor size. Propensity score matching (PSM) was used to balance baseline differences such as age and tumor stage between the two groups. Predictors of survival other than the surgical procedure were analyzed using a Cox regression model. In total, 6598 patients with stage IA lung adenocarcinoma undergoing SLR between 2011 and 2018 were enrolled, including 2061 and 4537 receiving segmentectomy and WR, respectively. The mean age was 60.3 ± 11.7 years, 66.2% were female, and 81.5% never smoked. After PSM, segmentectomy was associated with significantly better overall survival than WR (p = 0.019), especially for tumors larger than 2 cm (p < 0.001). Aside from segmentectomy, age ≤ 75 years, well-differentiated tumors, small tumor size, and the absence of nodal metastasis were associated with better overall survival. Segmentectomy offered superior overall survival for patients with tumors larger than 2 cm. For tumors smaller than 2 cm, the outcomes of segmentectomy and WR were comparable, offering flexibility in surgical decision-making. These findings highlight the need for individualized surgical approaches based on tumor characteristics.

Nutrition, Lifestyle, and Environmental Factors in Lung Homeostasis and Respiratory Health.

The lungs play a vital role in maintaining homeostasis by facilitating gas exchange and serving as a structural and immune barrier. External factors, including nutrition, lifestyle, and environmental exposures, profoundly influence normal lung function and contribute to the development, progression, and prognosis of various respiratory diseases. Deficiencies in key micronutrients, such as vitamins A, D, and C, as well as omega-3 fatty acids, can impair the integrity of the epithelial lining, compromising the lungs' defense mechanisms and increasing susceptibility to injury and disease. Obesity and physical inactivity further disrupt respiratory function by inducing structural changes in the chest wall and promoting a pro-inflammatory state. Environmental pollutants further worsen oxidative damage and activate inflammatory pathways. Addressing these modifiable factors through interventions such as dietary optimization, physical activity programs, and strategies to reduce environmental exposure offers promising avenues for preserving lung function and preventing disease progression. This review examines the molecular pathways through which nutrition, lifestyle, and environmental influences impact lung homeostasis.

Delaying disease progression in COPD with early escalation to triple therapy: a modelling study (DEPICT-2)

IntroductionIn patients with COPD, dual bronchodilator (long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA)) and triple therapy (inhaled corticosteroid/LAMA/LABA) reduce the risk of exacerbations and lung function decline in the short–mid-term, but their long-term impact is unknown. This modelling study explores long-term impact of these therapies on lung function decline, quality of life (QoL) and all-cause mortality.MethodsThis modelling approach used a longitudinal nonparametric superposition model using published data regarding exacerbations, QoL (assessed by St George's Respiratory Questionnaire (SGRQ)) and mortality. The model simulated disease progression from 40 to 75 years of age and assessed the impact of initiating dual bronchodilator at age 45 years (“LAMA/LABA only” group) and escalation to triple therapy at age 50 years (“Escalation to triple” group) on forced expiratory volume in 1 s (FEV1) decline, QoL and mortality.ResultsModel simulation predicted that by 75 years of age, “LAMA/LABA only” preserves 159.1 mL of FEV1versus no treatment, while “Escalation to triple” preserves an additional 376.5 mL and 217.3 mL of FEV1versus no pharmacotherapy and “LAMA/LABA only”, respectively. In “LAMA/LABA only”, the SGRQ score reduces (−3.2) versus no treatment, which further reduces to −7.5 in “Escalation to triple”. In “LAMA/LABA only”, mortality reduces by 5.4% by 75 years versus no treatment, while the “Escalation to triple” shows further decrease in mortality by 12.0%.ConclusionEarly pharmacotherapy initiation and escalation from dual bronchodilator to triple therapy could slow disease progression by preserving lung function and improving QoL and survival in patients with COPD.

Prevalence and Predictors of Response to Antifibrotics in Long-Term Survivors with Idiopathic Pulmonary Fibrosis.

The natural history of IPF remains unpredictable despite antifibrotic treatment. In addition, some patients discontinue treatment due to the occurrence of adverse events. To date, no data exist on either the effect of long-term treatment or predictors of treatment response. In the present study, we aim to evaluate the functional trajectory of IPF patients treated with antifibrotics for at least three years and to establish predictors of treatment response. This multicenter study enrolled long-term survivors IPF patients provided they had stopped treatment for no longer than one month during at least three-year study period. Based on the absolute decline of FVC%predicted (pred.) observed during the 3-year treatment and normalized per year, patients were defined as progressors (≥ 5%) or non-progressors (< 5%). We identify 172 IPF patients who completed three years of antifibrotic treatment with no interruption. The 27% of these IPF patients progressed despite complete adherence to treatment. Progressors were more likely to be non-smokerscompared to non-progressors, with higher occurrence of diarrhea and with a more preserved lung function at diagnosis. FVC %pred. and liters at diagnosis, a greater FVC decline in the 1-st year of follow up, being non-smokers, and complaining of diarrhea over treatment are independent predictors of progression. Almost one third of IPF patients adherent to three years of antifibrotics experience progression. A functional decline at first year of treatment despite preserved lung function at diagnosis, non-smoking status, and occurrence of diarrhea over treatment are independent predictors of disease progression.

Bacteriological Profile of Acute Exacerbation of Nonspecific Interstitial Pneumonia (NSIP)

Introduction: Nonspecific interstitial pneumonia (NSIP) is a life-threatening disease of unknown etiology, characterized by distinct radiographic and pathological patterns. Patients with NSIP often experience a progressive decline in respiratory function, or a more acute deterioration referred to as acute exacerbation (AE-NSIP). Among infectious agents, bacterial involvement and its impact on alveolar healing remain underexplored. Recent studies suggest that impaired host defence mechanisms may predispose NSIP patients to infections, thereby influencing disease progression. Aim: This study investigates bacterial isolates from sputum samples in patients with AE-NSIP and evaluates their clinical significance. Materials and Methods: Sputum samples from 120 AE-NSIP patients admitted to a tertiary hospital between January 2021 and January 2022 were analysed. Patients unable to produce sputum or those pre-treated with antibiotics were excluded. Gram staining and culture tests were conducted on high-quality sputum samples. Chi-square tests were used to determine the statistical significance of bacterial isolates. Results: Out of 120 patients, bacterial isolates were identified in 78.3% (n=94), while 21.7% (n=26) showed no isolates. Streptococcus pneumoniae (n=26) and Escherichia coli (n=24) were statistically significant (p&lt;0.05). Other isolates such as Haemophilus influenzae (n=16), Klebsiella pneumoniae (n=8), Enterococcus (n=4), and Moraxella catarrhalis (n=6) were statistically insignificant. Conclusion: Preservation of lung function in NSIP remains critical. The potential role of bacterial infections in worsening NSIP and the use of prophylactic antibiotics warrant larger, geographically diverse studies.

Anatomy-wise lung ventilation imaging for precise functional lung avoidance radiation therapy

Objective.This study aimed to propose a method for obtaining anatomy-wise lung ventilation image (VIaw) that enables functional assessment of lung parenchyma and tumor-blocked pulmonary segments. The VIawwas used to define multiple functional volumes of the lung and thereby support radiation treatment planning.Approach.A super-voxel-based method was employed for functional assessment of lung parenchyma to generate VIsvd. In the VIsvdof the 11 patients with tumor blockage of the airway, the functional value in tumor-blocked segments was set to 0 to generate the VIaw. The lung was divided into regions of high functional volume (HFV), unrecoverable low functional volume (LFV), and recoverable LFV (rLFV, the region in the tumor-blocked segment with a high function value based on the VIsvd) to design three intensity-modulated photon plans for five patients. These plans were an anatomical-lung-guided plan (aPlan), a functional-lung-guided plan (fPlan), and a recoverable functional-lung-guided plan (rfPlan) where the latter protected both HFV and rLFV.Main results.The LFV in the reference ventilation images and the tumor-blocked segments had a high overlap similarity coefficient value of 0.90 ± 0.07. The mean Spearman correlation between the VIawand reference ventilation images was 0.72 ± 0.05 for the patient with tumor blockage of the airway. TheV20 and mean dose of rLFV in rfPlan were lower than those in aPlan by 12.1 ± 8.4% and 13.0 ± 6.4%, respectively, and lower than those in fPlan by 14.9 ± 9.8% and 15.9 ± 6.5%, respectively.Significance.The VIawcan reach a moderate-strong correlation with reference ventilation images and thus can identify rLFV to support treatment planning to preserve lung function.