INTRODUCTION:Sarcoidosis data from the Middle East are limited, and regional studies have been predominantly single-ethnicity, leaving phenotyping in the region's diverse expatriate populations unexplored. We characterised pulmonary sarcoidosis across ethnic groups in Qatar and examined temporal trends over 9 years. METHODS:Retrospective cohort study of adults with pulmonary sarcoidosis managed at Hamad Medical Corporation, the principal public-sector provider in Qatar, between 2015 and 2023. The primary ethnic comparison was Arab versus South Asian. Because diffusion capacity (DLCO) was differentially ascertained, sensitivity analyses assessed the potential impact of missing data. RESULTS:We included 156 patients (64.7% male; median age 45 years; Arab 45.5%, South Asian 41.0%). Stage II predominated (67.3%); Stage IV was present in 15.4%. Histologic confirmation was achieved in 83.3%, primarily by EBUS-TBNA (single-procedure yield 94.3%). Corticosteroids were prescribed in 61.5%. South Asian patients were younger (43 vs. 50 years; p = 0.003), more frequently male (80% vs. 54%; p = 0.002), and reported constitutional symptoms more often (18.8% vs. 5.6%; p = 0.031). Among patients with available measurements, South Asians had lower median DLCO (78.0% vs. 90.5% predicted; p = 0.014); however, DLCO was measured in only 48.4% versus 70.4% of South Asian and Arab patients, respectively (p = 0.014), limiting interpretation. Asymptomatic presentation increased from 22% in 2015-2019 to 62% in 2020-2021 and 42% in 2022-2023. CONCLUSION:In Qatar's first pulmonary sarcoidosis cohort, disease was predominantly Stage II, with high EBUS-TBNA yield. South Asians had more constitutional symptoms; lower DLCO was observed but requires prospective confirmation. Pandemic-era imaging may have increased incidental detection.
BACKGROUND:Pulmonary surfactant is essential for neonatal respiratory distress syndrome (RDS) management, yet national data on how surfactant is used in China are limited. We surveyed current practices and variation in surfactant availability and administration. METHODS:In October-December 2022, a nationwide cross-sectional online survey was completed by one neonatologist from each of 394 hospitals across 30 provinces. Items covered surfactant availability (including delivery room access), product selection, dosing, timing, and administration techniques. RESULTS:Surfactant was available in 96.7% of hospitals; poractant alfa and calsurf were available in 88.6% and 58.1%, respectively. Only 51.6% of hospitals reported surfactant availability in delivery rooms. For the first dose, 200 mg/kg was preferred for poractant alfa (68.8%) and 100 mg/kg for calsurf (63.8%). The reported median time to first dose was 2.0 h after birth; poractant alfa was administered sooner than calsurf (10 vs. 30 min estimated administration time; p < 0.001). Most respondents (79.7%) reported giving surfactant after noninvasive ventilation failure in infants who subsequently required mechanical ventilation, with higher use in tertiary vs. secondary hospitals (82.1% vs. 71.7%; p = 0.03). Intubation-surfactant-extubation (INSURE) and less invasive surfactant administration (LISA)/minimally invasive surfactant therapy (MIST) were available in 86.5% and 49.7% of hospitals, respectively. Additionally, 25.1% of the respondents reported combining a surfactant with glucocorticoids for treating RDS. CONCLUSION:Surfactant use in China shows substantial between-hospital variation, particularly in delivery room access and less invasive administration. Standardized training and improved resource allocation may reduce disparities and support timely, evidence-based surfactant therapy.
ABSTRACT Background Pulmonary arterial hypertension (PAH) is a severe chronic obstructive pulmonary disease (COPD) complication, with vascular remodeling occurring early in disease progression. Oxidative stress, particularly NADPH oxidase subunit 4 (NOX4) activity, drives vascular smooth muscle differentiation, vasoconstriction, and proliferation, while Hypoxia‐inducible factor‐1α (HIF‐1α), activated by NOX4‐derived hydrogen peroxide (H2O2), plays a key contributory role in early pulmonary vascular remodeling. This study explores the roles of α‐smooth muscle actin (α‐SMA), NOX4, fibronectin (FN), and HIF‐1α roles in pulmonary microvascular remodeling in COPD patients without PAH. Methods Lung tissue samples from patients undergoing resection at General Hospital of Ningxia Medical University (Oct 2022–Dec 2023) were analyzed. Participants included COPD (n = 20) and control (n = 17) groups. NOX4, HIF‐1α, α‐SMA, and fibronectin expression in the pulmonary microvasculature (< 500 μm) were assessed via immunohistochemistry and Western blot. Smooth muscle remodeling (pulmonary vascular smooth muscle thickness percentage, WT%; pulmonary vascular smooth muscle area percentage, WA%) and serum vascular endothelial growth factor (VEGF) levels were evaluated. Results COPD patients exhibited significant thickening of the pulmonary microvascular smooth muscle layer, with endothelial cell swelling, degeneration, and necrosis. The WT% and WA% values of COPD patients were elevated compared to controls, alongside increased FN expression in the pulmonary microvasculature. NOX4, HIF‐1α, and α‐SMA expression levels were higher in COPD patients, particularly within endothelial cells and macrophages surrounding pulmonary vessels. The peripheral blood neutrophil count in the COPD group was higher than in the control group. Compared to the control group, COPD patients showed high expression of NOX4 and HIF‐1α in macrophages surrounding the pulmonary microvessels. Serum VEGF concentrations were significantly elevated in COPD patients and positively correlated with HIF‐1α expression in lung tissue homogenates. Conclusions Pulmonary microvascular remodeling occurs in COPD patients even without PAH, characterized by smooth muscle thickening, extracellular matrix deposition, and endothelial alterations. The NOX4‐HIF‐1α oxidative stress pathway, coupled with inflammatory cell activation, may contribute to microvascular remodeling in COPD.
ABSTRACT Background The Nijmegen Questionnaire (NQ) is used to identify Dysfunctional Breathing (DB) in individuals with asthma. However, it has not been validated for use in children and adolescents. Objective This study aimed to validate a Swedish NQ for this population. Methods Participants aged 10–17 years with asthma were included (n = 124). In Cohort I (n = 22), audiotaped semi‐structured interviews were conducted to adapt and refine the questionnaire analyzed by qualitative content analysis, resulting in NQ version 1. Forty‐eight participants (11 from Cohort I, 37 new) then completed version 1 to assess internal redundancy, consistency (Spearman's Rho, Cronbach's alpha) and item clarity, leading to version 2. Cohort II (n = 60 new) completed NQ version 2 alongside the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and Childhood/Adult Asthma Control Test (cACT/ACT) to assess construct validity. Cohort III (n = 54, 48 from Cohort II, 6 new) completed NQ version 2 again after 2 weeks for test–retest reliability. Results Content analysis prompted revisions for clarity and relevance. Internal redundancy ranged from rs = 0.00–0.69 and internal consistency was 0.85 (Cronbach's alpha). The NQ correlated moderately with cACT/ACT (rs = −0.54) and PAQLQ subscales Symptoms, Activity limitation and Emotional function, rs −0.52, −0.48, −0.39 (CI 0.32;0.70, 0.24;0.66, 0.14;0.60) respectively. Test–retest reliability was 0.86 (Kw) (p < 0.0001). Conclusion The Swedish Paediatric NQ seems to be a valid and reliable tool for identifying DB in children and adolescents with asthma.
ABSTRACT Sleeping difficulties are prevalent among adults with pulmonary hypertension (PH), with most individuals studied to date reporting poor sleep. However, research investigating the impact of sleep on psychological distress and health‐related quality of life (HRQoL) in PH remains limited. This study aimed to identify the nature of common sleep difficulties in PH and the associated psychosocial impact using multiple self‐reported measures. A cross‐sectional survey was conducted with 111 adults with PH recruited from PH associations globally. Most identified as White (91%) and female (82%). Participants completed measures of overall sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Scale), daytime sleepiness (Epworth Sleepiness Scale), anxiety (Generalised Anxiety Disorder‐7), depression (Patient Health Questionnaire‐9) and HRQoL (emPHasis‐10). Regression analyses were used to inspect relationships between measures and other PH variables. A total of 79.8% of participants were identified as having poor sleep quality. The most prevalent sleep‐related difficulties were sleep disturbance and sleep latency issues. Insomnia and daytime sleepiness rates were also elevated (35% and 33.6%, respectively) and often co‐occurred. In addition, 40% and 29% of participants had clinical levels of depression and anxiety, respectively. All types of sleep difficulties were associated with lower HRQoL. A series of parallel mediation analyses suggested that this association was partially mediated by depressive symptoms. The findings indicate the need to routinely screen for both sleep difficulties and mood disturbance in this population. Further work is needed to understand whether existing brief sleep interventions are effective for use in PH, where multiple factors are influencing sleep quality.
ABSTRACT Introduction Accurate diagnosis of peripheral pulmonary lesions (PPLs) remains challenging. Conventional forceps biopsy frequently yields small samples compromised by crush artifact. Transbronchial cryobiopsy (TBCB) offers larger, better‐preserved specimens. This study evaluated the diagnostic yield and safety of radial endobronchial ultrasound (r‐EBUS)‐guided TBCB using a 1.1‐mm cryoprobe. Materials and Methods This prospective single‐center study enrolled 73 consecutive patients with PPLs. Procedures were performed under general anesthesia using a laryngeal mask airway, a flexible bronchoscope, r‐EBUS for localization, and a 1.1‐mm cryoprobe inserted through a guide sheath. A prophylactic bronchial balloon blocker was employed for hemorrhage control. The primary outcome was diagnostic yield; secondary outcomes included bleeding severity and pneumothorax incidence. Results Mean lesion diameter was 21 mm, with 79.5% of patients exhibiting a positive bronchus sign. A definitive histological diagnosis was established in 55 of 73 patients (75.3%). Malignancies accounted for 60.3% of diagnoses, whereas benign etiologies, including tuberculosis, represented 15.1%. Bleeding occurred in 19.2% of cases; all events were mild and managed with the balloon blocker. No severe hemorrhage was observed. Pneumothorax occurred in six patients (8.2%), with four requiring chest tube drainage. Conclusion r‐EBUS‐guided TBCB using a 1.1‐mm cryoprobe is feasible and effective for diagnosing PPLs, with a diagnostic yield of 75.3%. Protocolized use of a balloon blocker effectively prevents severe hemorrhagic complications. Pneumothorax risk warrants vigilance, particularly in patients with infectious cavitary disease.
ABSTRACT Background Influenza is a leading cause of pediatric hospitalizations, with clinical presentations and outcomes varying between types A and B. This study compared the clinical characteristics and complications of children hospitalized with influenza A and B at the Sydney Children's Hospitals Network (SCHN) in the post‐COVID era. Methods We conducted a retrospective cohort study of children < 18 years admitted to SCHN with influenza during 2022–2023. Data on patient demographics, clinical presentations, complications, and management were extracted from electronic medical records. Group comparisons used chi‐square or Fisher's exact tests, and modified Poisson regression estimated adjusted risk ratios (RRs) with 95% confidence intervals (CIs) for key clinical outcomes. Results Among 704 influenza hospitalizations, 480 (68.2%) were due to influenza A and 224 (31.8%) to influenza B. Influenza B hospitalizations were more frequent in older children aged 5–< 18 years (67.4% vs. 57.7%) and associated with myalgia and pharyngitis, whereas influenza A hospitalizations were more common in children < 5 years (42.3% vs. 32.6%) and linked to cough, wheeze, and seizures. Although less common, influenza B hospitalizations exhibited greater clinical severity, with higher risks of noninvasive respiratory support (RR = 2.94; 95% CI 1.49–5.81) and intensive care unit (ICU) admission and/or mechanical ventilation (RR = 3.23; 95% CI 1.43–7.32). Conclusions Influenza B, though less prevalent, was associated with greater severity, particularly in older children. These findings underscore the importance of continued protection against both influenza types and support consideration of expanding vaccine access to children aged 5 years and older.
ABSTRACT Background Patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remain at risk of readmission and death after discharge. Opportunistic chest computed tomography (CT) body‐composition metrics may provide additional prognostic information beyond conventional clinical scores. Objective To develop and validate a 90‐day adverse‐outcome prediction model for hospitalized AECOPD using admission clinical variables and opportunistic chest CT body‐composition metrics. Methods A retrospective modelling cohort of 203 AECOPD admissions from the index centre was analysed. Admissions from 2021 to 2024 formed the development cohort (n = 152), and 2025 admissions formed the temporal‐validation cohort (n = 51). An external‐validation cohort from another centre included 103 admissions from records screened between 1 January 1 and 1 January 2025 after the model was locked. The primary outcome was 90‐day readmission or death. LASSO was used for variable screening in the development cohort. A feature‐count AUC plateau analysis and prespecified multialgorithm screening were used to lock the final model before validation. DECAF and BAP‐65 were retained as comparator scores. Results The 90‐day adverse outcome occurred in 66 of 152 development patients (43.4%), 18 of 51 temporal‐validation patients (35.3%) and 35 of 103 external‐validation patients (34.0%). LASSO retained prior AECOPD admissions, home oxygen before admission, diabetes mellitus, intermuscular adipose tissue area, long‐term NIV before admission, heart rate and coronary artery disease. Feature‐count analysis supported this seven‐predictor set, and multialgorithm screening selected HistGradientBoosting for validation. In temporal validation, the locked model achieved AUC 0.80 (0.64–0.95), sensitivity 0.78 (0.59–0.94), specificity 0.88 (0.76–0.97) and Brier score 0.15 (0.09–0.21), with imperfect calibration (Hosmer–Lemeshow p < 0.001). In external validation, the locked model achieved AUC 0.77 (0.66–0.87), sensitivity 0.66 (0.49–0.80), specificity 0.79 (0.71–0.88) and Brier score 0.18 (0.15–0.21); the Hosmer–Lemeshow p value was 0.209. Conclusions A 90‐day AECOPD prediction model combining clinical and opportunistic CT body‐composition variables showed consistent discrimination across validation cohorts, but calibration remained a key implementation boundary. Formal multicentre validation and calibration updating are needed before routine clinical use.
ABSTRACT Background High‐flow nasal cannula (HFNC) and bi‐level positive airway pressure (BiPAP) are both employed in the management of acute hypercapnic respiratory failure, yet their comparative benefits remain uncertain. We conducted an updated systematic review and meta‐analysis of randomized controlled trials (RCTs) to compare efficacy, safety, and tolerability of HFNC versus BiPAP in adults with hypercapnic respiratory failure. Methods We searched PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, and Wanfang Data through June 2025 for RCTs enrolling patients aged ≥ 16 years with arterial carbon dioxide partial pressure (PaCO2) > 45 mmHg. Primary outcomes were intubation rate and mortality. Secondary outcomes included arterial oxygen partial pressure (PaO2) or the ratio of PaO2 and inhaled oxygen fraction (FiO2; PaO2/FiO2), PaCO2, pH, respiratory rate, intensive care unit (ICU) length of stay, patient comfort, and device‐related complications. Results Eleven RCTs (n = 1069) met inclusion criteria. Intubation (risk difference [RD] = −0.02, 95% CI −0.06 to 0.03) and mortality rates (RD = −0.02, 95% CI −0.06 to 0.02) were similar between modalities. HFNC and BiPAP showed no significant difference in PaCO2 reduction (mean differences [MD] = 0.74 mmHg; 95% CI, −1.21 to 2.70) or pH normalization (MD = −0.01; 95% CI, −0.01 to 0), or ICU stay (MD = −0.72 days; 95% CI, −1.90 to 0.46). However, BiPAP yielded minor statistically significant improvements in oxygenation (standardized mean differences [SMD] = 0.18, 0.03–0.33) and respiratory rate reduction (MD = 2.06; 95% CI, 1.17 to 2.94). HFNC achieved higher comfort scores and fewer skin or gastrointestinal complications. Conclusion HFNC and BiPAP offer comparable clinical outcomes in acute hypercapnic respiratory failure. BiPAP offers modest physiological advantages, whereas HFNC provides better patient comfort and less adverse events. Large‐scale, multicenter RCTs are needed to further delineate the comparative benefits of HFNC versus BiPAP in diverse patient groups.
ABSTRACT Objectives The objective of this study is to examine the relationship between fluoroquinolone exposure and pneumothorax risk in patients hospitalized with pneumonia. Methods This retrospective cohort study used the TriNetX US Collaborative Network. We defined two mutually exclusive cohorts of hospitalized adults based on exposure to antibiotic classes commonly used to treat community acquired pneumonia: fluoroquinolone (ciprofloxacin, moxifloxacin, levofloxacin, and ofloxacin) versus nonfluoroquinolone (amoxicillin, azithromycin, ceftriaxone, and doxycycline). Patients with connective tissue disorders were excluded. The primary outcome was the occurrence of pneumothorax within 60 days. We used Cox proportional hazards regression to estimate hazard ratios (HRs) adjusted for demographics, comorbidities, and markers of illness severity. Results Among 1 140 106 eligible patients, 86 814 (7.6%) received fluoroquinolones. Fluoroquinolones as a class were not associated with risk of pneumothorax (HR 1.29, 0.95–1.76, Q = 0.21). Among individual fluoroquinolones, Ciprofloxacin alone was associated with an increased risk of pneumothorax (HR 2.26, 95% CI 1.38–3.69, Q < 0.01). Pooled nonfluoroquinolone antibiotics were associated with a modestly reduced hazard of pneumothorax (HR 0.79, 95% CI 0.69–0.91, Q < 0.01), although this effect was not consistent across individual agents. Conclusions Exposure to fluoroquinolones does not appear to impact the risk of pneumothorax in hospitalized adults with pneumonia. Only ciprofloxacin was associated with increased risk of pneumothorax. Future research in both clinical and experimental settings may help elucidate whether the mechanism by which fluoroquinolones affect the pulmonary pleura can vary by acute disease state. Our findings suggest that antibiotic selection for pneumonia should be guided by clinical appropriateness rather than attributable risk for pneumothorax.
ABSTRACT Background Chronic Obstructive Pulmonary Disease (COPD) is associated with reduced physical activity, negatively affecting prognosis and quality of life. According to Self‐Determination Theory (SDT), the quality of motivation plays a key role in sustaining active behavior, but evidence in COPD remains limited. Objective The objective of this study was to examine the associations between different types of exercise motivation and objectively measured physical activity and sedentary behavior in individuals with COPD. Methods This cross‐sectional study included 50 community‐dwelling individuals with COPD (GOLD stages 2–3; mean age 69.4 ± 7 years). Motivation was assessed using the Behavioral Regulation in Exercise Questionnaire (BREQ‐3) and the Self‐Determination Index (SDI). Physical activity was objectively measured with the ActiGraph GT3X accelerometer. Associations were examined using Spearman's correlations and hierarchical multiple linear regression models. Results Integrated regulation was positively correlated with light physical activity (rho = 0.43, p < 0.05), total physical activity (rho = 0.40, p < 0.05), and daily step count (rho = 0.43, p < 0.05). Intrinsic motivation was positively correlated with light physical activity (rho = 0.37, p < 0.05), total physical activity (rho = 0.37, p < 0.05), and daily step count (rho = 0.35, p < 0.05). The Self‐Determination Index was positively associated with light physical activity (rho = 0.28, p < 0.05) and daily step count (rho = 0.33, p < 0.05), but showed no significant association with sedentary time. In hierarchical regression analyses, higher levels of integrated regulation were independently associated with higher daily step count, with each one‐unit increase associated with 687 additional steps per day. For total physical activity, integrated regulation showed a borderline independent association with the outcome after adjustment for clinical covariates (β = 0.279, p = 0.054), whereas FEV 1 (% predicted) remained independently associated with total physical activity (β = 0.304, p = 0.027). For sedentary behavior, higher self‐determination was independently associated with lower sedentary time; specifically, each one‐unit increase in the Self‐Determination Index corresponded to approximately 13 fewer sedentary minutes per day (β = −0.327, p = 0.026). Conclusion Self‐determined motivation was associated with more favorable physical activity profiles in individuals with COPD. Integrated regulation was independently associated with daily step count, while higher self‐determination was associated with lower sedentary time. These findings suggest that autonomous forms of motivation may be important factors to consider when promoting active lifestyles in people with COPD.
BACKGROUND:Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children, with increasing macrolide resistance complicating treatment. Traditional Chinese Medicine (TCM) provides unique benefits for pediatric respiratory infections. PURPOSE:To evaluate the safety and efficacy of Lianhua Qingke (LHQK) tablets as adjunctive therapy in children with M. pneumoniae pneumonia (MPP). STUDY DESIGN:This prospective, multicenter, randomized, double-blind, placebo-controlled trial adhered to the Declaration of Helsinki and was registered in the Chinese Clinical Trial Registry (ChiCTR2300078209). METHODS:A total of 160 children aged 4-14 years with mild MPP were randomized 1:1 to receive conventional therapy plus LHQK or conventional therapy plus placebo for 7 days across 13 hospitals over 4 months. Efficacy analysis included 128 participants with centrally confirmed MP infection; safety analysis included all 160. Baseline characteristics were comparable (all p > 0.05), with 98.8% medication compliance in both groups (p > 0.05). The primary outcome was the major symptom resolution rate by Day 7. RESULTS:The LHQK group showed a significantly higher major symptom resolution rate (85.9% vs. 65.6%, p < 0.05), with a numerically shorter median time to resolution (4.5 vs. 5.0 days, p = 0.072). LHQK also significantly improved cough and expectoration relief rates (all p < 0.05). No differences were found in laboratory parameters. Adverse event incidence was lower with LHQK (2.5% vs. 8.8%, p > 0.05), with no serious events reported. CONCLUSION:LHQK is a safe and effective adjunctive TCM therapy for mild MPP in children, offering significant benefits in respiratory symptom alleviation and a favorable safety profile, with a trend toward shorter recovery time, providing a valuable treatment option amid rising antibiotic resistance.
ABSTRACT Chronic cough is defined as a cough lasting no less than 8 weeks, and 10%–42% of patients with chronic cough retain their cough after comprehensive examination and treatment. The terms idiopathic chronic cough (ICC), unexplained chronic cough (UCC), and refractory chronic cough (RCC) are frequently used to describe this clinical condition. However, these terms are often used interchangeably in articles, leading to heterogeneity in the populations included in the studies and compromising the value of the findings in guiding clinical practice. This article aims to clarify the current terminological confusion by reviewing the definitions and relationships among ICC, UCC, and RCC in the literature, and to discuss the emerging role of cough hypersensitivity syndrome (CHS) as an important pathophysiological framework for understanding chronic cough, with a focus on its clinical value, current challenges, and future perspectives.
Idiopathic pulmonary fibrosis is a progressive interstitial lung disease with limited treatment options and poor prognosis. Increasing evidence suggests that airway epithelial remodeling contributes to disease pathogenesis, yet the role of basal cells remains incompletely understood. This study aimed to determine whether basal cells participate in pulmonary fibrosis through a senescence-associated secretory phenotype regulated by the transcription factor SP1. METHODS:Lung tissue from patients with idiopathic pulmonary fibrosis who underwent transbronchial cryobiopsy was compared with control samples from patients undergoing lung resection for benign nodules. Histopathological analysis and immunohistochemistry were used to evaluate basal cell distribution and quantify cell-specific markers. Transcriptomic data from the GEO database were analyzed to identify differentially expressed genes and enriched signaling pathways. Findings were validated in a bleomycin-induced pulmonary fibrosis mouse model, and SP1 expression was assessed by protein analysis. RESULTS:Basal cells were markedly increased in fibrotic airways and extended from bronchioles into fibroblast foci, with their abundance correlating positively with fibrosis severity. Differential gene expression analysis identified enrichment of senescence-associated secretory phenotype-related pathways, including upregulation of metalloproteinases and chemokines. In the mouse model, senescence-associated mediators were significantly elevated, and SP1 expression was increased in fibrotic lungs. CONCLUSION:Basal cells may actively contribute to pulmonary fibrosis, and SP1-mediated senescence-associated secretory phenotype may represent a potential novel pathogenic mechanism. Targeting basal cell dysfunction or SP1-related pathways may offer new therapeutic opportunities for idiopathic pulmonary fibrosis.
ABSTRACT Introduction Whether obstructive sleep apnea (OSA) severity is independently associated with sarcopenia, beyond the effects of age, obesity and sex, has not been established in a single‐centre cohort using standardised ultrasound‐based assessment. We examined sarcopenia prevalence and its components across OSA severity strata in a Kuwaiti cohort using the ISarcoPRM sarcopenia algorithm. Methods Cross‐sectional within‐cohort analysis of 110 adults aged 50 years or older with confirmed OSA (apnea‐hypopnea index [AHI] 5 or more events/h by Level 3 portable monitoring; SomnoTouch, Somnomedics, Germany), stratified as mild (AHI 5–14.99, n = 28), moderate (AHI 15–29.99, n = 39) or severe (AHI 30 or more, n = 43). Sarcopenia was assessed using the ISarcoPRM algorithm: quadriceps muscle thickness by ultrasound, Sonographic Thigh Adjustment Ratio (STAR), handgrip strength (Jamar dynamometer) and chair stand test (CST). Results Demographic and comorbidity profiles were balanced across severity groups (all p > 0.05). Quadriceps muscle thickness, STAR and handgrip strength did not differ significantly across severity strata (all Kruskal–Wallis p > 0.05). CST time showed a significant gradient across severity strata (Kruskal–Wallis p = 0.047), and both AHI and ODI correlated modestly with CST time (r = +0.209, p = 0.029 and r = +0.203, p = 0.034, respectively). Sarcopenia prevalence was 21.4%, 30.8% and 34.9% in mild, moderate and severe OSA, respectively, with no significant trend (Cochran–Armitage p = 0.237). Age (OR 1.12 per year, 95%CI 1.05–1.19, p < 0.001) and BMI (OR 1.10 per kg/m2, 95%CI 1.02–1.18, p = 0.009) were the independent predictors of sarcopenia; OSA severity was not (adjusted OR 1.19, 95%CI 0.65–2.18, p = 0.577). Low STAR prevalence was 83.6%, driven by the high‐obesity burden in this cohort and the origin of STAR cut‐offs in a lower BMI Turkish reference population. Conclusion In this Kuwaiti OSA cohort, age and BMI are the dominant determinants of sarcopenia, with no independent contribution from OSA severity. A modest association between OSA severity indices and CST time suggests that physical function may be more sensitive to OSA‐related changes than muscle mass per se. The near‐universal low STAR prevalence points to the need for population‐specific normative data in high‐obesity cohorts.
ABSTRACT Background Exercise‐induced oxygen desaturation (EID) refers to a significant decrease in oxygen saturation (SpO2) during physical exertion, commonly observed in chronic obstructive pulmonary disease (COPD) patients. Definitions of EID vary widely between studies, leading to difficulties in comparing results and inconsistencies in clinical practice. Objective The objectives of this study were to evaluate (a) the different definitions of EID reported in the literature, (b) the prevalence of EID during the 6‐min walking test (6MWT) in a cohort of COPD patients undergoing pulmonary rehabilitation (PR), and (c) the agreement between the definitions. Methods A scoping review was conducted to assess existing EID definitions. The prevalence of EID in a cohort of postexacerbation COPD patients performing the 6MWT at admission to PR was retrospectively evaluated based on selected definitions. Agreement between definitions was assessed using Fleiss' kappa. Results Of the 244 articles reviewed, 62 met the inclusion criteria, and 23 definitions of EID were identified. The seven most cited definitions found were applied to 954 patients who completed the 6MWT at admission. The most common criterion was a ≥ 4% decrease in SpO2 during walking. The prevalence of EID varied between 15.6% and 38.7% depending on the criterion used. The overall agreement between the definitions was good, with a Fleiss kappa of 0.718. Conclusions In a large COPD cohort recovering from exacerbation, EID prevalence varied significantly depending on the definition used. Although good agreement was found between the criteria, the most conservative definition identified EID in only 15% of patients. Future studies will be necessary to determine which definition is most appropriate, predictive for outcomes, and useful for prescribing oxygen under effort.
AIMS:To investigate whether there is a correlation between the parameters of cardiopulmonary function tests and corticospinal diaphragm pathway parameters in healthy individuals. METHODS:Seventeen healthy adults participated in all tests. Transcranial magnetic stimulation (TMS) was employed to assess corticospinal diaphragm excitability, measuring the diaphragmatic resting motor threshold (DRMT), cortical motor evoked potential amplitude (CMEPA), and cortical motor evoked potential latency (CMEPL). Functional capacity was evaluated using the 6-min walk test (6MWT), pulmonary ventilation function was assessed via pulmonary function tests (PFT), and cardiopulmonary endurance was determined by cardiopulmonary exercise test. (CPET). The relationships between TMS-derived parameters and cardiopulmonary function indices were examined using correlation analysis and stepwise regression analysis. RESULTS:Regression analyses identified two key independent predictors. First, forced expiratory volume in 1 s (FEV1) was an independent predictor of DRMT. DRMT also correlated with other measures of pulmonary function and exercise capacity. Second, maximum heart rate (HRmax) was an independent predictor of CMEPL. CMEPL also showed positive correlations with other cardiopulmonary parameters. CONCLUSION:This study demonstrates that in healthy adults, better pulmonary function (reflected by higher FEV1) is associated with a higher DRMT and greater cardiovascular reserve (reflected by higher HRmax) is associated with longer CMEPL. These novel associations suggest a link between routine cardiopulmonary metrics and the central neural control of breathing, warranting further investigation.
BACKGROUND:Bronchial artery embolization (BAE) is preferred for massive hemoptysis. However, the suboptimal short-term and long-term therapeutic outcomes have necessitated the initiation of this study. The aim of this study was to identify risk factors that influence the recurrence of massive hemoptysis after BAE and determine active prevention and control measures to reduce recurrence. METHODS:Between January 2019 and November 2024, a total of 162 patients with massive hemoptysis underwent BAE, of whom 47 required re-embolization due to recurrence. Baseline data of patients, technical success, clinical success, recurrence, complications, and other relevant information were collected from outpatient and inpatient medical records and subsequently analyzed. The Cox regression analysis and Forest map were employed to analyze the risk factors associated with recurrence of massive hemoptysis after BAE. RESULTS:Findings suggested that the technical success rate was (160/162) 98.76% and clinical success rate was (115/162) 70.99% during the 12-month follow-up. Mean recurrence-free time was 26 ± 3.43 days (95% CI: 19.28-32.72) among 47 patients who experienced recurrence following BAE. Multivariate Cox regression analysis showed that the risk factors for early recurrence of hemoptysis following BAE were the extent of destroyed lung (OR = 0.562 [95% CI: 0.325-0.973], p = 0.04), whether preoperative computed tomography angiography (CTA) (OR = 0.204 [95% CI: 0.083-0.499], p = 0.001), or technical factors (OR = 4.621 [95% CI: 1.936-11.028], p = 0.001), while the risk factor for late recurrence was the progression of underlying diseases (OR = 6.071 [95% CI: 1.968-18.731], p = 0.002). However, the overall risk factors for recurrent hemoptysis after BAE included the extent of destroyed lung (OR = 0.606 [95% CI: 0.404-0.91], p = 0.016), whether preoperative CTA (OR = 0.49 [95% CI: 0.266-0.905], p = 0.023), technical factors (OR = 2.176 [95% CI: 1.089-4.348], p = 0.028), and the progression of underlying diseases (OR = 1.958 [95% CI: 1.047-3.662], p = 0.035. There were no major complications related to BAE requiring immediate treatment, and only minor complications were observed. CONCLUSION:This study preliminarily concludes that the extent of destroyed lung, whether preoperative CTA, technical factors, and the progression of underlying diseases are independent risk factors associated with hemoptysis recurrence after BAE. Through comprehensive preoperative assessments, individualized embolization strategies, and proactive postoperative management of underlying diseases, the risk of recurrent hemoptysis can be significantly reduced.
INTRODUCTION:Occupational asthma (OA) is a significant work-related respiratory disorder requiring accurate diagnostic methods. This study evaluates the sensitivity and specificity of PC20 variability in OA diagnosis and compares it with peak expiratory flow rate (PEFR) monitoring. METHOD:A retrospective descriptive study was conducted. Fifty-one individuals with suspected OA were assessed. Pulmonary function tests, PEFR monitoring, and methacholine challenge test were performed. PC20 variability was analyzed by comparing values during workplace exposure and after exposure cessation. RESULTS:A total of 51 suspected occupational asthma (OA) cases were evaluated (mean age: 38.14 ± 8.10 years, 68.6% male). The most common symptom was shortness of breath (mean duration: 19.61 ± 29.23 months), with an average occupational exposure of 7.34 ± 6.82 years, primarily to low molecular weight (LMW) agents. OA was diagnosed in 70.6% (n = 36) of cases, with longer symptom duration and exposure time than nonoccupational asthma. OA cases had longer symptom duration (22.50 ± 32.98 months vs. 12.67 ± 16.08 months in non-OA cases) and slightly longer occupational exposure (7.51 ± 5.94 years vs. 6.92 ± 8.83 years). PC20 (provocative concentration of methacholine causing a 20% fall in FEV1) variability was analyzed. IgE-mediated asthma was found in 16.7% of LMW-exposed cases, whereas nonimmunologic mechanisms accounted for 83.3%. PC20 levels were lower during exposure but improved after exposure cessation. PC20 variability was positive in 77.8% (n:28) of cases and had a sensitivity of 90% and a specificity of 92%. In 13.9% of OA cases, methacholine challenge test could not be performed due to low FEV1 levels, and diagnoses were made based on PEFR variability. If PC20 variability was not performed, PEFR variability alone could lead to misclassification in 22.2% (n:8) of cases. The majority of OA cases were associated with the metal, foundry, and ceramics industries, with inorganic dust exposure as the most common exposure (27.8%). CONCLUSION:PC20 variability is a highly sensitive and specific tool for diagnosing OA and may help reduce misdiagnosis associated with PEFR-based assessments. However, in patients where the methacholine challenge test is not feasible, PEFR variability remains a valuable alternative for diagnostic evaluation. Integrating PC20 variability into diagnostic protocols can enhance accuracy and improve patient management.
OBJECTIVE:To characterize the epidemiological profile, coinfection spectrum, and virus-virus association patterns between rhinovirus (RV; A/B/C) and influenza A virus (IAV). METHODS:We analyzed 8928 respiratory samples collected from April 2023 to December 2025. A quality-controlled RV analytic cohort (n = 386) and an IAV-positive cohort (n = 422) were used for subtype distribution, coinfection profiling, and observed-versus-expected co-occurrence analysis. Associations were evaluated with Fisher's exact test or chi-square test, with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS:In the RV cohort, subtype A was dominant (235/386, 60.9%), followed by C (118/386, 30.6%) and B (33/386, 8.5%); mixed subtypes accounted for 1.6% (6/386). Coinfection was common (282/386, 73.1%), and IAV was detected in 14/386 RV-positive samples. Co-occurrence analysis showed lower-than-expected overlap for IAV-RV A (0.23% vs. 0.40%), IAV-RV B (0.029% vs. 0.099%), and IAV-RV A/B/C overall (0.390% vs. 0.624%), while IAV-RV C was close to random expectation (0.217% vs. 0.210%). CONCLUSION:RV and IAV exhibited subtype-dependent interaction patterns in this regional cohort, with apparent mutual exclusion for RV-A/RV-B and near-random coexistence for RV-C. These findings support subtype-stratified surveillance and season-specific prevention strategies.
