Chronic obstructive pulmonary disease (COPD) remains underdiagnosed in smoking populations, as conventional risk stratification relies heavily on spirometry and fails to integrate dynamic imaging markers and type 2 inflammation biomarkers. To develop and validate a multifactorial prediction model integrating bronchodilator responsiveness, clinical features, imaging markers, and inflammatory biomarkers to identify, among smokers already undergoing routine spirometric assessment, those at highest risk for underdiagnosed or potentially progressive COPD. Retrospective cohort study. In this retrospective cohort study, 440 smokers treated between August 2015 and October 2024 were stratified into bronchodilator test-positive and test-negative groups (n = 220 each). Demographics, smoking history, respiratory symptoms, pulmonary function, imaging findings, fractional exhaled nitric oxide, and blood eosinophil counts were analyzed. Independent COPD-related factors were identified using logistic regression, model performance using receiver operating characteristic curves, and cumulative incidence outcomes via Kaplan-Meier analyses. Internal validation was performed using bootstrap resampling (200 repetitions) to assess model optimism. Positive bronchodilator test, age, smoking index, chronic bronchitis/emphysema, airway wall thickening, and elevated eosinophil counts were significantly associated with COPD. The model demonstrated strong diagnostic accuracy. A positive test independently conferred a 3-fold increased risk and identified a high-risk subgroup with a 3-year cumulative incidence of 45%. The integrated model detected 78.5% of high-risk cases an average of 2.3 years earlier, reduced unnecessary spirometry referrals by 27%, and increased early intervention rates by 19%. Bootstrap validation yielded an optimism-corrected C-index of 0.86. A positive bronchodilator test, when combined with a panel of clinical and inflammatory markers, constitutes a valuable multidimensional indicator for stratifying COPD risk among smokers, beyond what is captured by baseline spirometry alone. Integrating these factors into a predictive model may facilitate earlier detection of cases prone to being missed by standard diagnostic algorithms and enable more targeted monitoring and interventions. A simple tool using a breathing test plus other common factors to find smokers at highest risk for serious lung diseaseSmoking is the leading cause of chronic obstructive pulmonary disease (COPD), a major lung illness. Doctors use breathing tests (spirometry) to diagnose COPD, but these can miss early disease or fail to predict who will get worse quickly. Our study created and tested a practical scoring tool to better identify smokers at the highest risk. We looked back at data from 440 symptomatic smokers. We checked not just their standard breathing test but also a simple “reversibility” test (bronchodilator test), along with their age, smoking history, CT lung scan results, body weight, history of early birth, and two markers of inflammation from blood and breath. The key finding was that smokers with a positive reversibility test had a 3-times higher risk of developing COPD within 3 years. We combined this test result with seven other key factors into one risk score. This combined model was very good at pinpointing high-risk individuals, performing significantly better than a standard breathing test alone. Using this tool could help doctors spot 78.5% of high-risk cases about 2 years earlier, reduce unnecessary repeat breathing tests by 27%, and increase early treatment rates by 19%. In short, for smokers undergoing evaluation, this easy-to-use tool combines a simple breathing test with readily available health information. It helps doctors find which smokers need closer watch and earlier action, potentially improving COPD prevention and care.
Asthma is a chronic inflammatory disease of the respiratory system characterized by wheezing, shortness of breath, and chest tightness. Although effective medications are available to control symptoms and prevent exacerbations, optimal outcomes depend largely on adherence to evidence-based treatment guidelines. This study aimed to evaluate prescriber adherence to the Global Initiative for Asthma (GINA) guidelines, assess its impact on asthma symptom control, and identify challenges and barriers influencing guideline adherence. A sequential explanatory cross-sectional study supplemented with qualitative interviews was employed. The study was conducted from May 16 to August 30, 2023. Quantitative data were obtained through structured medical chart abstraction, followed by semi-structured interviews to explore barriers to guideline adherence. Data were analyzed using SPSS version 25, and associations between independent variables and asthma control were examined using ordinal logistic regression. Statistical significance was set at p < 0.05. Findings revealed that patients managed by prescribers not adhering to GINA guidelines had 72% lower odds of achieving symptom control (AOR = 0.28, 95% CI: 0.12-0.65, p = 0.003). Positive predictors of symptom control included monthly income of 5501-7000 ETB (AOR = 2.12, 95% CI: 1.02-4.40), mild persistent asthma compared with severe asthma (AOR = 2.63, 95% CI: 1.00-6.89), and use of low- or medium-dose budesonide plus formoterol inhalations daily (AOR = 8.26, 95% CI: 3.26-29.1, p = 0.001; AOR = 10.3, 95% CI: 3.27-32.6, p < 0.001, respectively). Conversely, married (AOR = 0.49, 95% CI: 0.25-0.98, p = 0.045) and divorced patients (AOR = 0.39, 95% CI: 0.19-0.81, p = 0.012), those prescribed medium-dose beclomethasone with salbutamol (AOR = 0.18, 95% CI: 0.07-0.45, p < 0.001), and patients with poor medication adherence (AOR = 0.36, 95% CI: 0.22-0.61, p < 0.001) showed significantly lower odds of symptom control. Qualitative findings highlighted barriers such as the extensiveness of the GINA guidelines, limited availability of recommended medications, and insufficient prescriber knowledge and training. Prescribers' non-adherence significantly compromised asthma control. Strengthening guideline implementation requires improving medication accessibility, training healthcare providers, and enhancing awareness to optimize asthma management. Prescriber adherence to treatment guidelines for the management of asthma symptom and how its impact on symptom controlAsthma is a common long-term disease that causes inflammation in the airways and cause to breathing problems such as shortness of breath, wheezing, and chest tightness. Medicines are often prescribed to control these symptoms and prevent future asthma attacks. This study aimed to find out whether physicians are following the Global Initiative for Asthma (GINA) treatment guidelines and how their adherence affects asthma symptom control among patients. It also explored the reasons why some providers do not fully follow the guidelines. The study used both quantitative and qualitative methods. From May 16 to August 30, 2023, researchers reviewed patient medical charts to collect important information and conducted interviews with healthcare providers to understand barriers to using the GINA guidelines. Data were analyzed using SPSS version 25, and relationships between variables were tested using ordinal logistic regression, with a significance level of p < 0.05. The findings showed that patients treated by physicians who did not follow the GINA guidelines were 72% less likely to have good symptom control of their asthma symptoms (AOR = 0.28, 95% CI: 0.12–0.65, p = 0.003). Better asthma control was linked with: Having a moderate monthly income (5501–7000 ETB) compared with higher income (>7001 ETB), having mild persistent asthma rather than severe asthma, and using budesonide plus formoterol inhalers daily, either in low or medium doses. Poorer asthma control was observed among: Married and divorced patients compared to single individuals, those using beclomethasone plus salbutamol inhalers, patients not adhering to their medications, and those treated by non-adherent prescribers .Interviews with prescribers revealed that poor adherence to the GINA guidelines was mainly due to: The complexity and length of the guidelines, limited access to recommended medications, and lack of training and awareness among prescribers.
Social determinants of health (SDOH) and health-related social needs (HRSN) drive disparities in lung function, nutrition, and survival in People with Cystic Fibrosis (PwCF). Addressing HRSN can improve access to care, yet standardized screening and intervention methods remain underutilized. The aim of this project was to develop, test, and refine a remote HRSN screening and intervention model across multiple cystic fibrosis (CF) centers. A multicenter, prospective Quality Improvement (QI) initiativeMethods:Four CF centers, serving both pediatric and adult populations, piloted an electronic HRSN screening tool and a remote social need intervention strategy. Developed collaboratively with CF clinicians and patient and family partners (PFPs), the tool assesses nine HRSN domains. Multidisciplinary teams, including PwCF, held regular meetings to tailor implementation to each site's existing clinical workflow and staff structure. Over 1 year, each site conducted iterative Plan-Do-Study-Act (PDSA) cycles every 2 weeks to refine the screening process, sharing adaptations across centers. All four CF centers successfully implemented the remote HRSN screening and intervention workflows, completing 26 iterative PDSA cycles to refine site-specific processes. Study site meetings were held with multidisciplinary attendance at 100% of meetings. The screening tool was integrated into pre-visit planning and telehealth workflows, allowing for social worker follow-up of identified needs. Multidisciplinary collaboration from all sites resulted in the generation of a comprehensive library of local and regional resources to support unmet needs identified during screening. Narrative patient testimonial highlighted the screening tool's effectiveness in facilitating discussions about social needs and connecting individuals to available resources from the perspective of PwCF. Our study has shown that HRSN screening and intervention are feasible, adaptable and acceptable to PwCF. Next steps include gathering comprehensive data on screening and intervention rates, domains of unmet social needs across regions, and sustainability interventions. Expanding HRSN screening and intervention to other CF Centers can provide data to support public policy and advocacy initiatives for reducing health disparities driven by SDOH. Screening for and addressing social challenges in people with cystic fibrosisSocial determinants of health (SDOH) are an individual’s personal circumstances that impact their overall health and well-being. SDOH can lead to health-related social needs (HRSN) that include limited access to healthy food, affordable housing, transportation, education, and access to health insurance. These factors have been shown to impact lung health, nutrition status, and survival in people with cystic fibrosis (CF). While the use of telehealth has increased access to care for many people with CF, it has also created some challenges in how we can help people get access to the social resources that they might need. The goal of our project is to test an HRSN screening tool and resource packet that can be used with telehealth in CF. We hope to increase identification of unmet needs and be able to provide remote interventions to connect people with resources and services that can help. Four different CF Programs tested a virtual HRSN screener and intervention packet. These teams meet regularly and work together to find the best way to use the screener and provide resources to patients who are in need, and patients and families at their center are helping to guide the process. Our goal is to improve access to care through picking up on areas of need and linking patients with resources without patients having to come into the clinic in-person. What we learn from this project can be used in other CF programs and can be used to develop resources for the national CF community.
Research into safe and effective treatments for alpha-1 antitrypsin deficiency (AATD) has been ongoing for more than four decades. There is still a high medical need for better treatment options: Safe, effective, and convenient therapies that target both the lungs and other AATD organ manifestations are eagerly awaited by patients. The purpose of this study is to provide a quantitative clinical-regulatory insight into the current status of the Food and Drug Administration (FDA) and European Medicines Agency (EMA) orphan drug approvals and designations for compounds intended to treat AATD. A cross-sectional approach was applied, involving a one-time comprehensive search of relevant databases. The primary endpoint of this study was to determine the number and nature of FDA and EMA-approved orphan drugs. The secondary endpoint was the registration of compounds with orphan drug designation status. All database searches were performed since the inception of the FDA database in 1983 and the EMA database in 2000, as well as for all compounds listed in the FDA and EMA drug label databases up to 20 January 2025. The search terms 'antitrypsin' and 'proteinase' were used. In 1987, the FDA approved the first human alpha1-proteinase inhibitor, representing the only approved active substance (5%) out of 20 with orphan drug designation in the FDA for the treatment of AATD. Conversely, the EMA has granted orphan drug designation to nine active substances, though none of these have yet been approved. However, there are several new active substances that have been granted orphan drug designation: oral neutrophil elastase inhibitor (FDA 2021, EMA 2025), IgG4 Fc-bound recombinant human AAT (FDA 2022), HSV vector therapy (FDA 2023), and A1AT modulator/protein folding stabiliser (FDA 2023, EMA 2024). Furthermore, the development of RNA interference therapeutics has progressed in the United States and Europe. The development of new therapies may offer expanded treatment options for patients with AATD in the future. In addition to pulmonary manifestations, extrapulmonary manifestations could also be treated in the future. New progress in developing medicines for Alpha-1 Antitrypsin Deficiency: an update from the FDA and EMAThe development of medicines to treat Alpha-1 Antitrypsin Deficiency (AATD) has been going on for over 40 years. So far, the only type of medicine approved by both the FDA and EMA for AATD are human alpha-1-proteinase inhibitors. There are five of these approved medicines listed by the FDA, and they differ in how they are made and what they contain. Only the first one was approved through the special orphan drug process. In Europe, two of these medicines are approved. One is called Respreeza, which is listed by the EMA, and the other is Prolastin, which has been approved in Germany since the 1980s by the Paul Ehrlich Institute. This is because the EMA was created only in 1995. These medicines aim to slow down lung damage caused by emphysema. Right now, there is no approved treatment for other symptoms of AATD outside the lungs. Recently, some new types of medicines have received orphan drug status, and some of them have shown good results in early clinical trials (phase I and II). There has also been progress in developing RNA interference treatments. If these new treatments continue to do well in testing, there might be a chance in the future to use a combination of these medicines for better treatment of AATD.
Therapeutic management of idiopathic pulmonary fibrosis (IPF) remains challenging. IPF patients frequently exhibit a hypercoagulable state, and anticoagulant therapy has emerged as a potential strategy; however, its clinical utility remains controversial. To systematically evaluate the efficacy and safety of anticoagulant therapy in IPF patients. Systematic review and meta-analysis of randomised controlled trials. Comprehensive searches were conducted in PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang Data, VIP, and CBM databases for randomised controlled trials (RCTs) investigating anticoagulant therapy in IPF, from database inception to February 2025. Two investigators independently screened the literature, extracted data, and assessed risk of bias. Meta-analysis was performed using RevMan 5.3. Seven RCTs involving 504 patients with IPF were included. Compared with control groups not receiving anticoagulants, anticoagulant therapy significantly improved PaO2 (MD = 11.64, 95% CI 7.09-16.18, p < 0.00001), SaO2(MD = 4.44, 95% CI 2.42-6.47, p < 0.0001), and HGF levels (MD = 108.74, 95% CI 88.58 to 128.90, p < 0.00001) but significantly reduced the mMRC score (MD = -0.38, 95% CI -0.62 to -0.14, p = 0.002) and D-dimer levels (MD = -0.08, 95% CI -0.11 to -0.05, p < 0.00001). No significant difference was observed in PaCO2 levels (MD = -4.26, 95% CI -9.09 to 0.56, p = 0.08). Anticoagulant therapy did not demonstrate benefit in reducing all-cause mortality (RR = 3.46, 95% CI 1.57-7.61, p = 0.002) or adverse reactions (MD = 1.44, 95% CI 1.15-1.81, p = 0.002). Anticoagulant therapy may offer clinical benefits in IPF management. However, its lack of mortality benefit and safety concerns warrant cautious interpretation. Clinicians should carefully assess individual bleeding risks before initiating treatment. Due to the limited number of included studies and data constraints, further large-scale, high-quality, multicenter, and long-term RCTs are needed. Future research should prioritise risk stratification, optimised anticoagulation protocols and identification of biomarkers predictive of bleeding risk to inform clinical decision-making. The study protocol was registered with PROSPERO (Registration number: CRD42022349940). Study combining results from multiple clinical trials to evaluate blood-thinning drugs for idiopathic pulmonary fibrosis (IPF) patientsStudy combining results from multiple clinical trials to evaluate blood-thinning drugs for idiopathic pulmonary fibrosis (IPF) patients Why was the study done? Idiopathic pulmonary fibrosis (IPF) is a serious lung disease with limited treatment options. Some studies suggest that blood-thinning drugs (anticoagulants) might help IPF patients because their blood tends to clot more easily. However, whether these drugs truly benefit patients or cause more harm remains highly debated. This study aimed to clarify the benefits and risks of anticoagulants for IPF. What did the researchers do? Researchers gathered and analysed data from all available high-quality clinical trials (published up to February 2025) comparing anticoagulants with no anticoagulants (or placebo) in IPF patients. They combined results from 7 trials involving 504 patients to assess effects on breathing (oxygen levels, shortness of breath), blood markers, survival, and side effects. What did the researchers find? Potential benefits: Anticoagulants improved blood oxygen levels (PaO2 and SaO2), reduced shortness of breath (mMRC score), and lowered blood clotting markers (D-dimer) and a disease-related factor (HGF). No clear change: Blood carbon dioxide levels (PaCO2) were unaffected. Important risks: Anticoagulant therapy did not demonstrate benefit in reducing all-cause mortality or adverse reactions. What do the findings mean? While anticoagulants may improve some symptoms in IPF patients, these potential benefits are outweighed by significantly higher risks of death and adverse effects. Anticoagulants are not recommended as routine treatment for IPF. If considered for individual patients, doctors must carefully weigh bleeding risks. More large, long-term studies are needed to confirm these findings. Future research should focus on: Identifying which patients might benefit safely, Developing safer anticoagulant strategies, Finding biomarkers to predict bleeding risk.
Initial regimen selection is critical for pulmonary arterial hypertension (PAH) management and survival. Since 2015, guidelines have recommended upfront combination therapy as the standard of care in newly diagnosed patients. To highlight real-world treatment patterns and predictors of initial combination therapy. Retrospective cohort analysis of U.S. administrative claims from 01 January 2013 (Optum's de-identified Clinformatics® Data Mart Database [CDM]) or 01 July/2015 (IQVIA PharMetrics® Plus) through 30 September 2020. Patients initiating PAH medications (phosphodiesterase-5 inhibitors (PDE5i), soluble guanylate cyclase stimulators (SGCS), endothelin receptor antagonists (ERA), or prostacyclin analogues (PCY)) were identified and indexed on the first medication date. All PAH medications identified between index and 365 days post-index were identified and classified as PDE5i/SGCS/ERA monotherapy, PDE5i/SGCS + ERA dual therapy, or PCY-containing regimen. Treatment regimens were analyzed by index year, physician specialty, and among physician specialists associated with a Pulmonary Hypertension Care Center. Multivariable regression was conducted to identify patient characteristics predictive of the first-line regimen. 1754 (CDM) and 1107 (IQVIA PharMetrics Plus) met selection criteria. The most initiated first-line regimen was PDE5i/SGCS/ERA monotherapy (CDM: 61.2%; IQVIA PharMetrics Plus: 50.9%). The proportion of CDM patients initiating PDE5i/SGCS + ERA dual therapy increased from 13.1% in 2013 to 21.9% in 2019; for IQVIA PharMetrics Plus, PDE5i/SGCS + ERA dual therapy remained consistent (24.4% in 2015, 23.7% in 2019). More pulmonologists prescribed PDE5i/SGCS + ERA dual therapy (CDM: 30.2%; IQVIA PharMetrics Plus: 38.6%) than cardiologists (CDM: 18.3%; IQVIA PharMetrics Plus: 24.3%). PHCC patients were prescribed first-line dual therapy (35.7% vs 26.9%) and PCY-containing regimens (30.3% vs 21.7%) more frequently than non-PHCC patients, respectively. Females (vs males) were more likely to receive dual therapy and PCY-containing regimens; Black (vs White) patients were less likely to receive PCY-containing regimens. Additional research is needed to better understand barriers to optimal initial treatment regimen selection and to quantify the impacts of therapeutic delay. Use of combination treatment in patients with pulmonary arterial hypertensionWhy was the study done?Selecting the treatment approach for newly diagnosed pulmonary arterial hypertension (PAH) is critical for improving patient survival. Research has shown that patients newly diagnosed with PAH who are started on combination therapy experience less disease progression, hospitalization, and death, than those started on monotherapy. Thus, experts now recommend starting treatment in patients with newly diagnosed PAH using a combination of medications, but it is not clear if this is happening.What did the researcher do?Using two large databases, with data spanning from 2013-2020, this study explored the treatment approaches used for newly diagnosed patients with PAH and found patient factors that influenced treatment selection.What did the researchers find?In total, 1,754 and 1,107 patients were identified from each database. In both databases, more than one-half of patients started PAH treatment with one medication (61.2% and 50.9%). However, combination treatments did increase over time (from 13.1% in 2013 to 21.9% in 2019), and in the other database, dual therapy stayed at approximately 24% from 2015 to 2019. Females were more likely than males to receive dual therapy. Lung specialists and doctors at specialty care clinics were more likely to start patients on combination treatments.What do the findings mean?Even though clinical guidelines recommend starting PAH therapy using combination treatments, most patients are initiating therapy with only one medication.
Bronchiectasis is a chronic, complex, and heterogeneous respiratory disease characterized by irreversible bronchial dilation, persistent airway inflammation, and recurrent infections. Traditionally viewed from a lung-centered perspective, its pathophysiology has been explained by the "vicious cycle" hypothesis, later refined into the more dynamic concept of the "vicious vortex." However, emerging evidence highlights the pivotal role of comorbidities in influencing disease progression, symptom burden, and prognosis. This review explores the evolving understanding of bronchiectasis by integrating comorbidities into current pathophysiological frameworks. We illustrate how coexisting conditions interact with components of the vicious vortex, amplifying airway inflammation, impairing host defenses, and disrupting clearance mechanisms. We summarize evidence on the prevalence, clinical impact, and prognostic significance of key comorbidities and discuss their implications for patient management. Finally, we emphasize the importance of an integrated, multidisciplinary approach and the emerging role of the treatable traits framework, which focuses on identifying clinically relevant, biologically measurable, and modifiable traits-regardless of whether they are etiological or nonetiological. In this sense, we propose a conceptual "Copernican Revolution" in bronchiectasis care: recognizing comorbidities not as secondary features, but as potential drivers of disease trajectory. By adopting this pragmatic strategy, clinicians can optimize quality of life, achieve patient-centered care, and improve outcomes in this condition. Looking beyond the lungs: how other health problems shape bronchiectasisBronchiectasis is a chronic lung condition characterized by persistent cough, mucus accumulation, and recurrent chest infections. Historically considered a disease confined to the lungs, emerging research highlights the significant role of comorbidities in influencing its development, progression, and severity.In this review, we examine how conditions such as asthma, chronic obstructive pulmonary disease (COPD), upper airway disorders, gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD) not only coexist with bronchiectasis but may also exacerbate its clinical course. Other important comorbidities—including cardiovascular disease, osteoporosis, malnutrition, periodontal disease, anxiety, diabetes and depression—are associated with increased exacerbation frequency, more frequent hospitalizations, and reduced quality of life. We also explore the role of immune system dysfunction, particularly primary immunodeficiencies, as potential underlying causes of bronchiectasis that warrant targeted diagnostic evaluation. Clinical tools such as the Bronchiectasis Aetiology Comorbidity Index (BACI) can assist clinicians in assessing the burden and prognostic impact of comorbidities. This review advocates for a paradigm shift: moving beyond a lung-centric model toward a holistic approach that recognizes bronchiectasis as a multisystem condition. This perspective emphasizes the early identification of comorbidities, implementation of practical screening strategies, and collaboration with specialists such as dieticians, psychologists, and immunologists. Addressing comorbid conditions alongside the management of bronchiectasis may alleviate symptoms, reduce infection rates, and improve overall well-being. We propose that this integrated, patient-centered approach will lead to more effective and individualized care for individuals living with bronchiectasis.
Some novel anticancer agents are associated with drug-induced interstitial lung disease (ILD), a critical and potentially fatal adverse event. Lung cancer patients appear particularly susceptible, yet the risk and clinical characteristics remain incompletely analyzed. To comprehensively evaluate ILD risk and characteristics induced by novel anticancer agents in non-small cell lung cancer (NSCLC) using large-scale real-world data. A retrospective pharmacovigilance study based on spontaneous adverse event reports. Data from 2014 to 2024 were extracted from the Food and Drug Administration Adverse Event Reporting System (FAERS). Reports of NSCLC patients who developed ILD during treatment with FDA-approved novel anticancer agents (immune checkpoint inhibitors, targeted therapies, antibody-drug conjugates). The reporting odds ratio (ROR) was used to assess the disproportionate reporting signals for each drug. Statistical significance was defined when the lower 95% confidence interval (CI) exceeded 1 with at least three reports. A total of 4712 NSCLC cases were analyzed. Eight agents were identified with positive signals for ILD: ROR and 95% CI for nivolumab was 1.28 (1.20-1.38), pembrolizumab 1.47 (1.36-1.59), durvalumab 7.38 (6.90-7.89), atezolizumab 1.25 (1.12-1.39), ipilimumab 1.96 (1.74-2.21), tremelimumab 3.58 (1.97-6.50), trastuzumab-deruxtecan 3.14 (2.29-4.30), osimertinib 1.12 (1.03-1.23). The median onset time was 33 days, with 48.59% of ILD events occurring within the first month. The fatal cases experienced a significantly shorter onset time than non-fatal cases. Older age, male sex, and lower body weight were identified as factors affecting ILD, whereas lower body weight, male sex, and a higher number of concomitant drugs were linked to increased mortality. Our study identifies positive signals for ILD with eight novel antineoplastic agents in NSCLC, including nivolumab, pembrolizumab, durvalumab, atezolizumab, ipilimumab, tremelimumab, trastuzumab-deruxtecan, and osimertinib, highlights the importance of monitoring during the first month of therapy, and identifies older male patients with lower body weight as a high-risk group. Understanding the risk of interstitial lung disease from novel anticancer agents in NSCLC patientsWhy was the study done?Novel anticancer agents, including targeted therapies, immune checkpoint inhibitors (ICIs), and antibody-drug conjugates (ADCs), have improved outcomes for patients with non-small cell lung cancer (NSCLC). However, these drugs can sometimes cause interstitial lung disease (ILD), a potentially serious lung condition. Previous studies have been limited by small patient numbers and strict inclusion criteria, leaving gaps in knowledge about the risk and characteristics of ILD in real-world settings.What did the researchers do?We analyzed data from the FDA Adverse Event Reporting System (FAERS), a large-scale, real-world database, to assess ILD risk associated with novel anticancer agents in NSCLC patients. We examined which drugs were more likely to induce ILD, when the ILD started, and what patient characteristics might increase the risk.What did the researchers find?Eight drugs showed positive signals for ILD: nivolumab, pembrolizumab, durvalumab, atezolizumab, ipilimumab, tremelimumab, trastuzumab-deruxtecan, and osimertinib. Durvalumab had the strongest signal. Nearly half of ILD cases occurred within the first month of treatment, highlighting the importance of early monitoring. Male sex, older age, and lower body weight were associated with higher ILD risk.What do the findings mean?This study provides real-world evidence to guide safer drug selection and highlights the need for personalized monitoring in NSCLC patients receiving novel anticancer therapies. Clinicians should closely monitor patients during early treatment and consider individual risk factors to reduce the likelihood of severe ILD and improve patient safety.
Interstitial lung disease (ILD) leads to progressive lung function decline and significant respiratory symptoms. Although antifibrotic agents preserve lung function and reduce mortality in ILD, their impact on health-related quality of life (HRQoL) remains unclear. We aimed to evaluate whether antifibrotic agents improve HRQoL and their effectiveness in treating HRQoL-related symptoms in patients with ILD. Systematic review and meta-analysis. A literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library from inception to August 25, 2025. The search included terms related to ILD, antifibrotic agents, and measures of HRQoL. HRQoL outcomes were assessed using the St. George's Respiratory Questionnaire (SGRQ), including total and domain scores. Data were pooled using a random-effects model, with outcomes reported as mean differences (MD) or relative risks (RR) and heterogeneity evaluated using the I² statistic. A total of 13 randomized controlled trials were included. Antifibrotic agents showed significant improvement in SGRQ scores, particularly in the symptom (MD: -2.59, 95% confidence interval [CI]: -4.56 to -0.61; I² = 32%) and activity (MD: -2.88, 95% CI: -4.82 to -0.94; I² = 34%) domains. Antifibrotics reduced the rate of cough (RR: 0.77, 95% CI: 0.64-0.94; I² = 0%) and dyspnea (RR: 0.71, 95% CI: 0.56 to 0.89; I² = 0%). However, fatigue was frequently observed in patients treated with antifibrotics (RR: 1.48, 95% CI: 1.20-1.83; I² = 0%) compared with the non-antifibrotic group. Most trials were judged to have low-to-moderate risk of bias, and the certainty of evidence was rated very low for total SGRQ scores but low to moderate for domain-specific outcomes and symptoms. Antifibrotic agents may improve HRQoL and reduce dyspnea and cough in patients with ILD, but the certainty of evidence is low, and they may increase fatigue, requiring careful monitoring.Trial registration:The study protocol was registered in PROSPERO (CRD42023450917). Do antifibrotic drugs help people with lung disease feel better in daily life?Interstitial lung disease (ILD) is a group of diseases that cause scarring in the lungs. This scarring makes it harder to breathe and can lead to symptoms like coughing, shortness of breath, and feeling very tired. These symptoms can affect a person’s daily life and overall well-being. Doctors often use antifibrotic medications (such as pirfenidone and nintedanib) to slow down the lung damage in ILD. These drugs can help prevent the lungs from getting worse over time. But it hasn’t been clear whether these treatments actually help patients feel better in their daily lives. To find out, we looked at the results of 13 clinical trials that included nearly 4,500 people with ILD. We focused on how these medications affected symptoms like breathlessness and coughing, as well as how patients felt overall. We also looked at treatment-related problems, especially tiredness (fatigue), which is common in people with lung disease. We found that people who took antifibrotic medications had some improvement in their breathing and physical activity. They also coughed less and felt less short of breath compared to people who didn’t take these drugs. However, many people who took antifibrotics reported feeling more tired than those who didn’t. In summary, antifibrotic medications may help people with ILD feel better in some ways, especially by improving breathing and reducing coughing. But they can also make people feel more tired. These benefits and side effects should be discussed between patients and their doctors to make the best treatment decisions. However, because the studies done so far are not very large and sometimes give mixed results, we cannot be completely sure yet. More research will help us understand better.
Accurate tools for patient stratification by likely outcome are needed to support complex decision-making and improve acute non-invasive ventilation (NIV) delivery. To evaluate the potential of an emerging NIV outcomes (NIVO) score tool to predict in-hospital mortality to aid its validation in a real-world UK hospital population of ward-based NIV for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This was a retrospective observational cohort study of all consecutive patient admissions with AECOPD managed with NIV for acute hypercapnic respiratory failure at a teaching hospital. Clinical parameters were collected as part of an ongoing quality improvement project. Patients were grouped based on their survival status at hospital discharge. First admission of each patient was included in the analysis. NIV failure, defined as NIV withdrawal or intubation requirement due to clinical deterioration on NIV, along with in-hospital mortality, was modelled using logistic regression. There were 249 unique patient AECOPD admissions with ward-based NIV. Across first admissions, NIV failure rate was 37.3%, in-hospital mortality 26.5%, and 1-year mortality 47.0%. NIVO score was significantly associated with both NIV failure and in-hospital mortality, with odds ratios (95% Confidence intervals) of 1.33 (1.13-1.58, p < 0.001) and 1.52 (1.26-1.86), p < 0.001, respectively. A progressive increase in in-hospital mortality was observed with increasing NIVO scores (p < 0.0001). This study demonstrates that the NIVO score shows promise as a predictive tool for in-hospital mortality in patients with AECOPD receiving ward-based NIV. Furthermore, it suggests that NIVO may be able to support decision-making for enhanced NIV delivery in new clinical pathways to address the growing burden of chronic obstructive pulmonary disease exacerbations. Predicting death in patients with chronic obstructive pulmonary disease (COPD) who need breathing support through a mask on hospital wardsPeople with long-term lung conditions like bronchitis or emphysema - often called chronic obstructive pulmonary disease (COPD) - can sometimes have flare-ups that make it hard to breathe. In these patients, doctors may use a breathing machine to help them breathe more easily using a mask. This breathing machine is called non-invasive ventilation. However, it can be difficult for doctors to know which patients are more likely to benefit from this machine and which are not. In our study, we looked at a new scoring system called the Non-Invasive Ventilation Outcomes (NIVO) score. This score is designed to help doctors predict which patients are more likely to die in hospital or for whom the breathing machine might not work. We aimed to provide information to help this tool be used in the future, for doctors to make better decisions about when to use this treatment. We reviewed the medical records of 249 patients who came to hospital and needed this breathing machine because their COPD had worsened. Some patients came to hospital more than once, so patients came to the hospital 314 times in total. We found that patients with a higher NIVO score were more likely to die and the breathing machine was less likely to help them recover. Also, when we grouped patients by their NIVO scores, those in the higher score groups had a greater risk of dying than those with lower scores. Our findings suggest that the NIVO score could help doctors predict which patients using the breathing machine are most at risk. This could help doctors decide who might benefit from this treatment in the future and improve how this treatment is used. Ultimately, this could lead to better care for patients with COPD.
Bronchiectasis exacerbations are a significant contributor to morbidity and mortality. While environmental factors, such as viral infections, are well-established triggers for exacerbations, the role of intrinsic factors, particularly chronic bacterial infections, remains incompletely understood. In this context, we sought to investigate the impact of chronic bacterial infections using the COVID-19 pandemic as a natural experiment, providing a unique opportunity to assess the effects of reduced external infections. A retrospective observational cohort study was conducted involving patients with non-cystic fibrosis bronchiectasis. Data were collected via telephone interviews and medical record reviews, comparing exacerbation rates before (2019) and during (2020) the pandemic. The difference in exacerbation rates between 2020 and 2019 (delta exacerbations) served as the dependent variable in a multiple regression model. Sixty-three patients were included in the analysis. Those without chronic bacterial infections showed a significant reduction in exacerbations during the pandemic: mean (SD) was 1.06 (1.3) versus 1.61 (1.3), respectively (p-value = 0.006). In contrast, no such reduction was observed in patients with chronic bacterial infections. Notably, chronic infection with Pseudomonas aeruginosa emerged as an independent predictor of sustained or increased exacerbations in 2020 (positive delta exacerbations), despite the implementation of social distancing measures. While social distancing effectively reduced bronchiectasis exacerbations in patients without chronic bacterial infections, those with Pseudomonas aeruginosa infections remained vulnerable to exacerbations, underscoring the importance of intrinsic disease/host factors. These findings highlight the need for targeted management strategies addressing chronic infections in patients with bronchiectasis. How chronic infections affect bronchiectasis flare-ups.This study looked at how ongoing lung infections affect people with bronchiectasis, a lung condition that causes coughing and breathing problems. The researchers found that in people without long-term infections, the number of flare-ups (times when symptoms get worse) decreased when they wore protective devices like masks or avoided exposure to infections from others. But for those who had a long-lasting infection with a germ called Pseudomonas aeruginosa, flare-ups didn’t improve. This means that having a chronic infection makes the lung condition harder to manage. The findings show that people with these ongoing infections may need special treatments to keep their lungs healthier and reduce flare-ups.
Interstitial lung diseases (ILDs) are a heterogeneous group of disorders with complex etiologies and nonspecific clinical manifestations, often requiring histopathological confirmation for accurate diagnosis. Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive alternative to surgical lung biopsy (SLB) for obtaining lung tissue, yet its role in multidisciplinary discussion (MDD) remains underevaluated. This study aimed to assess the diagnostic yield and safety of TBLC when integrated into MDD for diagnosing ILDs. A retrospective dual-center study was conducted on 208 patients with undiagnosed ILDs who underwent TBLC at Shanghai Chest Hospital and Fuzhou Pulmonary Hospital from May 2021 to December 2024. TBLC procedures were performed under general anesthesia, with samples evaluated by pathologists and integrated into MDD involving pulmonologists, radiologists, and rheumatologists. Diagnostic yield, complication rates, and concordance were analyzed. TBLC achieved a histological diagnostic yield of 88.9% (185/208 cases), which improved to 97.6% (203/208 cases) after MDD. The most common diagnosis was hypersensitivity pneumonitis (HP, 18.3%) followed by idiopathic nonspecific interstitial pneumonia (iNSIP, 15.4%). Complications were rare, with pneumothorax occurring in 5.3% of cases and moderate bleeding in 3.4%. No procedure-related mortality was observed. TBLC is a safe and effective diagnostic tool for ILDs, with high diagnostic yield when integrated into MDD. TBLC reduces the need for SLB while maintaining low complication rates. These findings support TBLC as a valuable component of the MDD approach for ILDs. The role of transbronchial lung cryobiopsy (TBLC) in multidisciplinary discussion (MDD) for interstitial lung diseases (ILDs): a dual-center retrospective studyBackground Interstitial lung disease (ILD) is often difficult to diagnose and may require a lung tissue sample. Surgical biopsy is effective but invasive. A less invasive procedure, called transbronchial lung cryobiopsy (TBLC), is now available, but its value in a team-based diagnostic approach needs further confirmation. Objective This study evaluated how effective and safe TBLC is when its results are reviewed by a multidisciplinary team (MDD) for diagnosing ILD. Methods We reviewed data from 208 patients with undiagnosed ILD at two hospitals in China. All patients underwent TBLC. Their biopsy results were then discussed by a team of lung specialists, radiologists, and pathologists to reach a final diagnosis. Key Results TBLC alone provided a clear histological diagnosis in 88.9% of cases. After the multidisciplinary team discussion (MDD), a final diagnosis was reached in 97.6% of cases. The most common final diagnoses were Hypersensitivity Pneumonitis and Idiopathic Nonspecific Interstitial Pneumonia. The procedure was safe: pneumothorax occurred in 5.3% and moderate bleeding in 3.4% of patients. No deaths were related to the procedure. Conclusion Transbronchial lung cryobiopsy (TBLC) is a safe and effective diagnostic tool for ILD. When its results are integrated into a multidisciplinary team discussion, the diagnostic success rate is very high. This supports TBLC as a valuable alternative to more invasive surgical biopsy.
Pulmonary arterial hypertension (PAH) remains progressive despite contemporary background therapy. Sotatercept is a novel activin signaling inhibitor that targets pulmonary vascular remodeling and may improve clinical and hemodynamic outcomes. To evaluate the efficacy, hemodynamic effects, and safety of sotatercept in patients with PAH. Systematic review and meta-analysis of randomized controlled trials (RCTs). Five electronic databases were searched through October 2, 2025, for eligible RCTs. Time-to-event outcomes were analyzed using pooled individual patient data with hazard ratios (HRs), while secondary outcomes were assessed using random-effects risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CI). Trial-sequential analysis (TSA) evaluated the conclusiveness of results. In four RCTs (n = 889), sotatercept reduced clinical worsening or death by 77% (HR 0.23, 95% CI 0.16-0.32, p < 0.001) and prolonged event-free survival by ~40 weeks. World Health Organization (WHO) functional class improved in 40.3% vs 24.3% (RR 1.71, 95% CI 1.32-2.21), and 6-minute walk distance increased by MD 30.27 m (95% CI 13.45-47.08), while pulmonary vascular resistance (PVR) declined significantly (MD -247 dyn·s·cm-5, 95% CI -301.7; -192.2). Serious adverse events were slightly less frequent with sotatercept (26.2% vs 31.7%, RR 0.83); however, total bleeding (37.9% vs 18.7%, RR 2.00), epistaxis (26.7% vs 5.4%, RR 4.89), and telangiectasia (19.8% vs 6.4%, RR 3.24) were more common. TSA revealed conclusiveness in clinical worsening, WHO functional class, and PVR, as well as increases in bleeding events and epistaxis. Sotatercept significantly improves clinical outcomes and extends event-free survival in PAH, with an acceptable safety profile; however, caution is warranted regarding bleeding events. These results support its role as an add-on therapy in PAH management. PROSPERO ID: CRD420251166414. New hope for pulmonary hypertension: sotatercept significantly improves exercise capacity and reduces disease progressionPulmonary arterial hypertension (PAH) is a serious and progressive condition in which high blood pressure in the lungs places strain on the heart, often leading to heart failure and death. Current treatments help control symptoms but rarely stop the disease from getting worse. Sotatercept is a new medication that targets abnormal blood vessel growth and helps restore normal vessel function. This study combined results from four high-quality clinical trials including 889 adults with PAH who were already receiving standard therapy. Half the participants received sotatercept injections every three weeks, and the other half received placebo. Researchers looked at how long patients remained free from major disease events, such as hospitalization or worsening symptoms, and also measured exercise capacity and heart–lung function. Patients who received sotatercept were 77% less likely to experience disease worsening or death compared with those on placebo. On average, they could walk about 30 meters farther during a six-minute walk test, and their heart pressures and blood vessel resistance improved significantly. The drug also increased overall event-free survival by around 40 weeks. While most side effects were mild or moderate, nosebleeds and small visible blood vessel spots on the skin (telangiectasia) were more common with sotatercept, and a few patients experienced higher hemoglobin levels or mild decreases in platelets. Overall, sotatercept was well tolerated and showed strong evidence of improving daily function and reducing the risk of clinical deterioration. These findings support its use as an additional therapy for adults with PAH who continue to have symptoms despite standard treatments. Further long-term studies are recommended to confirm its impact on survival and long-term safety.
Therapeutic advancements utilizing modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) have revolutionized the treatment of people with cystic fibrosis (pwCF). Elexacaftor-Tezacaftor-Ivacaftor (ETI) is a highly effective modulator therapy and has been shown to improve health outcomes in people with CF (PwCF). Due to these therapeutic advancements, many pwCF are getting older, but little is known regarding the safety and efficacy of ETI in pwCF at a more advanced age. We aimed to determine the effect of ETI on clinical outcomes in older pwCF. This study was a single-center, retrospective analysis of pwCF who received open-label ETI following FDA approval and were over the age of 40 at the time of ETI initiation. Data were obtained from the electronic medical record from a large CF center in the United States of America between November 2019 and January 2021, including body mass index (BMI), lung function as % predicted FEV1 before ETI initiation, and approximately 3 months and one a follow-up visit within 9-15 months post-ETI initiation. The exacerbation frequency over 12 months was recorded before and after ETI initiation. Forty-two patients met the inclusion criteria. Mean age at time of ETI initiation was 47.9, 23 patients (54.8%) were male, and 11 (26.2%) were homozygous for the F508del mutation. Linear mixed effects models suggest a monthly increase of 0.24 (95% CI 0.08-0.41, p = 0.003) for ppFEV1 and 0.03 (95% CI 0.002-0.06, p = 0.036) for BMI post-ETI, resulting in a 2.96 (95% CI 0.98-4.95) increase in ppFEV1 and 0.39 (95% CI 0.03-0.76) increase in BMI approximately 1-year post-ETI. In addition, a significant decline in pulmonary exacerbations was seen in the year following ETI initiation (1.5 ± 1.3 exacerbations/year prior vs 0.5 ± 0.7 exacerbations/year post; p < 0.0001). Treatment with ETI in this unique cohort of pwCF was safe. Whereas ETI affected BMI in a subtle way, initiation of ETI was associated with stabilization of lung disease with a significant but moderate increase in lung function and a decline in the number of exacerbations in the follow-up period. Longer and larger studies will be needed to analyze the effect of ETI on an aging CF population. Modulator therapy in an aged cystic fibrosis cohortCystic fibrosis is a genetic disease, which affects multiple organ systems often from birth on leading to a markedly decreased life expectancy. Over the last decades, optimization of care and more treatment options especially medication that restores the defective chloride channel ultimately responsible for the disease manifestations changed this poor prognosis and people with cystic fibrosis can live into their 60s. While most clinical trials focused on a “younger” representative patient population studying the effects of the first triple combination of these chloride channel correctors (Elexacaftor, Tezacaftor, Ivacaftor – ETI), our study focused on assessing the effect of ETI on an older population showing that they also tolerated ETI well and experienced improvement in their lung function and a decrease in hospitalizations due to cystic fibrosis flare ups, which were both statistically significant and comparable to ETI effects seen in different CF populations.
Pulmonary arterial hypertension (PAH) is a progressive, life-altering disease that imposes profound physical, psychological, and economic burdens on patients and caregivers. Therapeutic advances over the past three decades, most recently the introduction of sotatercept, have improved survival and functional outcomes. Despite this, many of the most pressing needs remain unseen, particularly those related to health-related quality of life (HRQoL). Patients often face years of diagnostic delays, and once diagnosed, experience fragmented care delivered across subspecialties. Rural, minority, and low-income populations encounter disproportionate barriers to specialty access, underscoring the role of social determinants of health (SDoH) in shaping outcomes. Alongside these systemic barriers, patients report high rates of depression, anxiety, fatigue, and social isolation-burdens that are frequently underestimated in clinical practice. To better capture the lived experience of PAH, patient-reported outcome measures (PROMs) provide insights beyond hemodynamic and survival metrics. HRQoL instruments such as the SF-36, CAMPHOR, PAH-SYMPACT, and EmPHasis-10 demonstrate validity in identifying high-risk patients, measuring treatment effects, and predicting outcomes. Despite their promise, challenges such as unclear minimal clinically important differences (MCIDs), workflow barriers, and limited uptake have hindered widespread integration. In parallel, supportive and palliative care services remain underutilized, despite strong evidence that early adoption improves symptom control, communication, and quality of life. This state-of-the-art narrative review proposes a two-tier framework for understanding PAH-related burdens. Patient-level burdens-including psychological distress, functional limitations, and treatment burden-can be addressed through integrating PROMs, HRQoL instruments, palliative, and mental health care. System-level burdens-driven by SDoH, racial and ethnic inequities, geographic barriers, and insurance gaps-require policy reforms, telehealth expansion, community partnerships, and greater diversity in research and clinical trials. Future progress in PAH depends on aligning therapeutic advances with what matters most to patients. Embedding specific PROMs into risk stratification, establishing MCIDs, leveraging digital tools for longitudinal monitoring, and integrating multidisciplinary and palliative services into pulmonary hypertension (PH) clinics will advance patient-centered care. Simultaneously, addressing system-level inequities through policy, community, and research initiatives will ensure equitable access and outcomes. By moving beyond survival to encompass the full spectrum of lived experience, PAH care can evolve into a holistic, patient-centered model.
Chronic obstructive pulmonary disease (COPD) is a leading global health burden, with high prevalence of comorbidities (e.g., hypertension and diabetes) that further increase healthcare utilization and mortality. Integrated care is proposed as a potential management strategy for COPD patients with comorbidities, but its overall effects remain unclear due to inconsistent evidence from prior studies. To systematically evaluate the effects of integrated care on key health outcomes in patients with COPD and at least one comorbidity. Systematic review and meta-analysis. Databases including MEDLINE, EMBASE, CENTRAL, CINAHL, and ClinicalTrial.gov were searched. Eligible studies were randomized controlled trials (RCTs) evaluating integrated care in patients with COPD and comorbidities. Two independent reviewers conducted study screening, data extraction, and quality assessment. Effects of integrated care were assessed using a random-effects model. Seven RCTs from high-income countries were included. Common integrated care components were health education, self-management support, and (in two studies) telemonitoring. Meta-analysis showed that integrated care significantly reduced the number of COPD exacerbations and all-cause hospitalizations. No significant effects were observed for all-cause emergency visits or CAT scores. Integrated care effectively reduces COPD exacerbations and all-cause hospitalizations in patients with COPD and comorbidities, supporting its clinical value. However, high heterogeneity across studies, limited generalizability to non-high-income countries (e.g., China), and lack of impact on patient-reported outcomes (CAT scores) highlight the need for further localized research. Registered with PROSPERO, Registration ID: CRD420251170533. COPD and comorbidities: the effects of integrated careChronic obstructive pulmonary disease (COPD), a serious lung condition affecting millions worldwide, often occurs alongside other health problems (e.g., heart disease, diabetes). These additional conditions can worsen outcomes, increasing hospital stays and even death. While “integrated care” (combining treatments, education, and long-term support) is often recommended for such patients, its benefits need clearer evidence. This study reviewed seven high-quality clinical trials from wealthier countries to evaluate how integrated care affects COPD patients with other health issues. Most programs included education, self-management training, and remote health monitoring. Key findings: Integrated care reduced sudden worsening of COPD symptoms (“exacerbations”). It also lowered the chance of being hospitalized for any health reason. However, it did not significantly reduce emergency room visits or improve patients’ self-reported symptom scores (CAT scores). These results suggest that integrated care can help stabilize COPD patients and reduce hospital stays, making it a valuable approach for healthcare systems. However, more research is needed to adapt these programs for low-income regions and to improve their impact on quality of life.
Females with cystic fibrosis (fwCF) are at increased risk of urinary incontinence (UI), likely due to chronic coughing and elevated intra-abdominal pressure. Prevalence rates reported in the literature vary widely, and no large multicenter study has been carried out to date. To estimate the prevalence and severity of UI in fwCF and to investigate clinical variables associated with UI. A multicenter, cross-sectional study conducted across 21 Italian CF centers. UI prevalence and severity were assessed using two validated questionnaires. A multivariable fractional polynomial approach was used to select variables for inclusion in the final logistic regression model to identify relevant associations with UI. UI was present in 218/542 females (40.2%, 95% Confidence Interval (CI): 36.1-44.5). Among children and adolescents, the prevalence was 12/160 (7.5%, 95% CI: 4.1-13), whereas among adults it was 206/382 (53.9%, 95% CI: 48.8-59). FwCF with UI showed a BMI of 0.2 Z score higher (95% CI: 0.1-0.4) than fwCF without UI; however, the overall prevalence of UI in fwCF overweight was 41% (95% CI: 30.2-52.7) compared to 40.1% (95%CI: 35.6-44.7) in fwCF with normal weight. Age (interquartile range-odds ratio (IQR-OR) 4.19, 95% CI: 2.80-6.28), days of hospitalization (IQR-OR 1.72, 95% CI: 1.42-2.08), and physical activity (OR 0.66, 95% CI: 0.53-0.82) were the only factors statistically associated with UI. UI affects mostly adult fwCF and is associated with older age and longer hospitalization. Physical activity of ⩾150 min per week was also associated with a reduced probability of UI. How Age, Hospitalizations, and Physical Activity Are Linked to Urinary Incontinence in People with Cystic FibrosisThis study looked at how common urinary incontinence (UI) is among females with cystic fibrosis (fwCF) in Italy, and what factors might be linked to it. UI is thought to be more common in fwCF because of frequent coughing and pressure in the belly. Researchers collected data from 21 cystic fibrosis centers using two questionnaires. A total of 542 females took part. They found that 40% of fwCF had UI. It was much more common in adults (54%) than in children and teens (7.5%). Women with UI had slightly higher body mass index (BMI), but being overweight didn’t seem to increase the risk compared to those with normal weight. The study found that three factors were strongly linked to UI: being older, spending more days in the hospital, and doing less physical activity. Interestingly, women who exercised more than 150 minutes per week had a lower risk of UI. This suggests that staying physically active might help prevent or reduce urinary problems in females with cystic fibrosis. In summary, urinary incontinence is common among adult females with cystic fibrosis and is linked to age and time spent in the hospital. Regular physical activity appears to offer some protection.
Chronic Obstructive Pulmonary Disease (COPD) is a common and prevalent condition that poses a significant threat to human health. Respiratory muscle fatigue is one of the common clinical manifestations of COPD. Currently, no effective treatment has been proposed to alleviate COPD symptoms. Respiratory neuromuscular electrical stimulation (RNES) enhances diaphragmatic contraction, lung volume, and ventilation through selective activation of type II muscle fibers, as evidenced in neurological and respiratory critical care settings. Although many COPD patients are managed through community care interventions, the efficacy of RNES in treating COPD patients has not been sufficiently studied. Here, we aim to investigate whether RNES can improve exercise capacity in COPD patients, as measured by 6-minute walk distance (6MWT). To determine the efficacy of a community-based pulmonary rehabilitation (PR) program incorporating RNES on exercise capacity and symptoms in COPD patients. To evaluate its feasibility as a novel, affordable and accessible community PR model for COPD management. This is a prospective, multicenter, randomized, parallel-controlled clinical trial, enrolling 60 patients with COPD. Sixty patients with stable COPD receiving inhalation therapy in 11 community health service centers in Beijing will be enrolled in the study. The potential of RNES to improve exercise capacity within this population will be explored in the study cohort. The enrolled patients will be randomized into two groups in a 1:1 ratio: control group (to receive conventional treatment) and experimental group (to receive conventional treatment plus RNES). During the treatment, the control group will receive conventional treatment without RNES, and those in the experimental group will receive 20/40 treatments over 6/12 weeks (1 session per day for 30 min) of RNES rehabilitation-assisted therapy plus conventional treatment. The primary outcome is exercise capacity based on changes in 6MWT at 12 weeks. The secondary outcome measures include changes from baseline in several indicators: dyspnea questionnaire, impact on daily living, anxiety and depression, pulmonary function, diaphragm function, respiratory muscle strength and body composition. This clinical trial is designed to investigate whether rehabilitation assistance therapy with RNES will improve diaphragm mobility, respiratory muscle strength and endurance, enhance pulmonary ventilation, tidal volume, and promote alveolar carbon dioxide excretion in patients with stable COPD, which will improve the activity and exercise capacity. This study investigates the feasibility of RNES as a scalable rehabilitation intervention for COPD management in community healthcare settings. RNES will improve exercise capacity, quality of life in patients with COPD. The protocol has been registered at the Chinese Clinical Trial Registry (ChiCTR2200061675).
Asthma is a heterogeneous inflammatory airway disease increasingly recognised to be associated with elevated cardiovascular risk. Arterial stiffness, commonly assessed by pulse wave velocity (PWV), is a well-established predictor of cardiovascular events. However, it remains unclear whether vascular involvement in asthma reflects true arterial stiffening or predominantly altered arterial wave reflection. To investigate arterial stiffness and wave reflection characteristics in patients with controlled and uncontrolled asthma compared with healthy controls. Cross-sectional observational study. A total of 158 participants (56 healthy controls, 50 patients with controlled asthma, and 52 patients with uncontrolled asthma) underwent non-invasive arterial stiffness and hemodynamic assessments. Peripheral and central blood pressures, PWV, augmentation pressure, augmentation index and reflection magnitude were measured. Group comparisons were performed using unadjusted analyses and multivariable analysis of covariance (ANCOVA). Multivariate analysis of covariance (MANCOVA) was used to evaluate wave reflection parameters simultaneously, adjusting for age, body mass index, smoking status, heart rate and systolic blood pressure. PWV differed significantly between groups in unadjusted analyses, with higher values observed in asthma groups. However, this association was no longer significant after multivariable adjustment, with age and systolic blood pressure emerging as the strongest independent determinants of PWV. In contrast, MANCOVA revealed a significant overall group effect on wave reflection parameters. Subsequent univariate analyses demonstrated that reflection magnitude remained significantly higher in both controlled and uncontrolled asthma groups compared with healthy controls after adjustment, whereas augmentation pressure and augmentation index did not show independent group effects. Vascular involvement in asthma appears to be characterised primarily by altered arterial wave reflection rather than overt arterial stiffening. These findings suggest that vascular alterations observed in asthma are primarily related to changes in arterial wave reflection and may be influenced by systemic hemodynamic factors (e.g. blood pressure and body composition), rather than asthma control itself. Blood vessel function in asthma: why wave reflection matters more than arterial stiffnessPeople with asthma showed differences in blood vessel function compared with individuals without asthma; however, after accounting for age and blood pressure, asthma was not independently associated with increased arterial stiffness. In contrast, blood pressure wave reflection remained higher in people with asthma regardless of asthma control status, suggesting that vascular involvement in asthma may primarily reflect early functional hemodynamic changes rather than permanent arterial stiffening. These findings indicate that assessing wave reflection parameters may add value to cardiovascular risk evaluation in patients with asthma beyond standard measures of arterial stiffness.
Composite nutritional and immune indices (NIIs) have been associated with chronic lung diseases (CLDs). However, systematic research on their associations with different CLD subtypes and potential threshold patterns remains limited. To examine cross-sectional associations between multiple NII and CLD subtypes, and to explore potential linear/nonlinear relationships and threshold ranges using a representative dataset. Cross-sectional, population-based study using National Health and Nutrition Examination Survey (NHANES) data. Data were obtained from the US NHANES from 2007 to 2012. Participants aged 18-79 years with complete blood and baseline data were included. Survey-weighted regression models were used to assess associations between NIIs and CLDs. Restricted cubic spline (RCS) regression models were employed to explore linear/nonlinear relationships and potential threshold ranges. The study included 5837 participants (mean age 49.82 ± 16.15). Regression analyses revealed significant associations between NIIs and CLDs across different ranges. RCS analysis identified thresholds for each NII: prognostic nutritional index (PNI) levels > 46.04 showed a significant inverse association with emphysema and chronic bronchitis. Elevated platelet-to-lymphocyte ratio (PLR) (>113.57) and MLR (>0.14) were positively associated with these conditions. systemic immune-inflammation index (SII) (>429.43) and neutrophil-to-lymphocyte ratio (NLR) (>0.99) were associated with a higher prevalence of asthma, emphysema, and chronic bronchitis. In this cross-sectional population-based study, NIIs were associated with different CLD subtypes, with evidence of potential threshold patterns. These findings may help inform future epidemiological studies and hypothesis generation, while causal inference and clinical application require further longitudinal validation. Nutritional and immune indices in chronic lung disease: NHANES 2007-2012Chronic lung diseases (CLDs) like asthma, emphysema, and chronic bronchitis are major health issues. In this study, we explored the association between nutritional and immune indices (NIIs) and CLDs. These indices measure a person’s nutrition and immune function. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012, focusing on adults aged 18-79. We examined how different NIIs related to CLDs and identified key threshold values that could predict disease risk. Our results showed that higher levels of prognostic nutritional index (PNI) were linked to a lower risk of emphysema and chronic bronchitis. In contrast, higher levels of platelet-to-lymphocyte ratio (PLR) and MLR were associated with a higher risk of these diseases. Additionally, elevated levels of systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) were connected to a greater risk of asthma, emphysema, and chronic bronchitis. More importantly, we clarified specific values and constructed a new predictive framework. This study provides a useful framework for predicting CLD risk based on simple measurements. It can help doctors detect these diseases early and improve prevention and treatment strategies for patients.