Hemoptysis is a common and challenging clinical emergency, frequently secondary to high-prevalence diseases in China-such as pulmonary tuberculosis, bronchiectasis, lung cancer, and pulmonary mycosis-as well as respiratory interventional procedures. Patients with life-threatening massive hemoptysis can succumb to asphyxia or hemorrhagic shock within minutes. Currently, clinical practices in hemoptysis management across China exhibit significant disparities among different regions and hospital tiers, characterized by an overall deficit in rescue capabilities and high rates of mortality and disability. The establishment of hemoptysis centers, drawing on the experience of chest pain centers and stroke centers, has become imperative. Several hospitals across various provinces and municipalities in China have already established Hemoptysis Centers, yielding favorable clinical outcomes, and an increasing number of hospitals nationwide are actively advancing the development of these centers. To ensure the standardized and orderly establishment of these centers, the Chinese Thoracic Society, the Chinese Antituberculosis Association, the Interventional Pulmonology Group of the Chinese Association of Chest Physicians, and the Hemoptysis Expert Committee of the Haemorrhage Professional Committee of the Chinese Research Hospital Association convened national experts in related fields to formulate these Expert Recommendations on the standardized established of hemoptysis centers. As the first consensus of their kind both domestically and internationally, these recommendations aim to standardize the establishment of Hemoptysis Centers, promote the development of a nationwide Hemoptysis Center network, improve the success rate of hemoptysis treatment, and reduce the mortality and disability rates of affected patients.
Objective: To evaluate the efficacy and safety of direct oral anticoagulants (DOAC) in the treatment of non-triple-positive antiphospholipid syndrome (APS)-associated pulmonary thromboembolism (PTE). Methods: A retrospective analysis was conducted on APS patients who were definitively diagnosed with PTE at the First Affiliated Hospital of Chongqing Medical University from July 2016 to July 2021 and met the Sapporo diagnostic criteria. Patients were divided into a DOAC group (n=34; 19 males, 16 females, mean age 57.0±17.7 years) and a warfarin group (n=9; 3 males, 6 females, mean age 37.7±15.0 years) based on the type of oral anticoagulant. Baseline data and laboratory findings were collected for both groups. Efficacy and safety outcomes, including venous thromboembolism (VTE) recurrence, death, and anticoagulation-related bleeding, were compared between the two groups. Results: No statistically significant differences were observed in baseline data between the two groups except for age. In terms of efficacy, thrombosis recurrence occurred in 2 patients (5.9%) in the DOAC group, while no recurrence occurred in the warfarin group; there was no statistically significant difference in VTE recurrence between the 2 groups (P=1.000). No deaths occurred in either group during follow-up, with no statistically significant difference in mortality. Regarding safety, bleeding occurred in 4 patients (4/34, 11.8%) in the DOAC group and 3 patients in the warfarin group, with a risk ratio of 0.353 (95% confidence interval: 0.096-1.301); the difference was not statistically significant (P=0.147). Conclusion: DOAC may be non-inferior to warfarin in both efficacy and safety for the treatment of non-triple-positive APS-associated PTE.
Echocardiography is a non-invasive technique for evaluating pulmonary thromboembolism (PTE), facilitating a dynamic assessment of cardiac structure, function, and hemodynamic alterations. It is critical in the auxiliary diagnosis, risk stratification, and prognosis assessment of acute PTE; monitoring the progression of chronic PTE; and conducting early screening for chronic thromboembolic pulmonary hypertension and evaluating right heart function in such cases. In current clinical practice in China, right heart echocardiographic assessment protocols for PTE are not standardized, resulting in image acquisition and interpretation variability. To address this challenge, our research group invited multidisciplinary specialists from relevant fields across China to engage in collaborative discussions. Based on a comprehensive review of both Chinese and international literature, and in alignment with the specific circumstances of clinical practice in China, the measurement methods, technical considerations, normal reference values, and clinical implications of each parameter used in echocardiographic assessment of the right heart for PTE were systematically summarized, and operational standards and recommendations suitable for the Chinese clinical setting were proposed. This document was developed on the basis of a systematic literature review and expert consensus.
The clinical data of 5 patients with hemoptysis who received bronchial artery embolization (BAE) with the extracorporeal catheter fenestration technique after failed conventional catheterization were retrospectively analyzed. The time spent on catheter fenestration, superselective catheterization of target vessels and intraoperative radiation exposure dose were recorded. The technical success rate, clinical efficacy and postoperative complications were evaluated, and long-and medium-term follow-up was conducted to observe the recurrence of hemoptysis. All 5 patients successfully underwent superselective catheterization with modified catheters, with a technical success rate of 100% and an immediate postoperative hemostatic efficacy rate of 100%. No severe perioperative complications such as vascular dissection, ectopic embolism and spinal cord ischemia occurred. During follow-up, hemoptysis did not recur in 3 patients, while recurrent hemoptysis occurred in 2 patients at 4 months and 1 year after surgery, who received secondary embolization treatment respectively. Preliminary results indicate that the extracorporeal catheter fenestration-assisted superselective catheterization technique is safe and feasible for difficult catheterization caused by anatomical variations. It can simplify the catheterization procedure and reduce radiation exposure, serving as a simple and economical remedial strategy for hemoptysis patients with failed conventional catheterization, which is worthy of clinical promotion.
Chronic obstructive pulmonary disease(COPD) remains a leading cause of mortality worldwide, and spirometry is the essential objective test for identifying airflow obstruction and confirming COPD in the appropriate clinical context. In 2026, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Global Lung Function Initiative(GLI) published a joint statement on the use of spirometry to define airflow obstruction and diagnose COPD. This statement reframes the long-standing debate between the fixed FEV1/FVC ratio and the lower limit of normal(LLN), emphasizing that these criteria should not be viewed simply as competing definitions, but as tools serving different clinical and epidemiological purposes.GOLD continues to recommend a fixed post-bronchodilator FEV1/FVC ratio of <0.70 to confirm persistent airflow obstruction in symptomatic individuals with relevant exposures, whereas GLI supports using the LLN to identify physiological airflow obstruction across populations, particularly to mitigate age-related misclassification. The joint statement further highlights that major global challenges extend beyond threshold selection to include the underuse of spirometry, variable test quality, and the interpretation of spirometric results without sufficient clinical context. Furthermore, spirometry alone is insufficient for diagnosing COPD; however, normal spirometric findings from technically acceptable tests can help exclude COPD. Results near diagnostic thresholds warrant repeat testing or further clinical evaluation.The statement also supports transitioning to the 2022 GLI race-neutral reference equations while cautioning that predicted values and severity classifications require careful interpretation across diverse populations. Regarding severity grading, both GOLD percent-predicted thresholds and ATS/ERS z-score classifications possess inherent limitations. Consequently, physiological impairment should be evaluated alongside symptoms, exacerbation risk, comorbidities, imaging findings, and clinically meaningful outcomes.This review summarizes the main viewpoints of the GOLD-GLI joint statement, focusing on the practical differences between the fixed ratio and LLN, barriers to spirometry implementation, quality assurance, reference equations, and severity grading. In addition, we integrate recent Chinese community-based and real-world evidence, including simplified pre-bronchodilator spirometry for population screening, portable spirometry in primary care, and artificial intelligence-assisted spirometry interpretation. By combining updated international consensus with local evidence and emerging technologies, this article provides a practical reference for standardizing COPD diagnosis and optimizing screening strategies in China.
A 69-year-old female presented with persistent wheezing for more than six months, which worsened with cough over the past week. External chest CT showed right-sided pleural effusion and a large soft-tissue mass in the right thorax. With a history of breast cancer, she was initially suspected of having a malignant intrathoracic tumor. On admission, thoracentesis with drainage and PET-CT were performed, yielding no conclusive evidence of malignancy. CT-guided percutaneous biopsy of the mass revealed hepatic tissue pathologically. In view of her previous traffic accident, upper abdominal MRI and diaphragmatic ultrasound were performed, confirming a diagnosis of right-sided traumatic diaphragmatic hernia. The patient was referred to the Thoracic Surgery Department. This case report intends to deepen respiratory physicians'knowledge of traumatic diaphragmatic hernia, improve diagnostic and therapeutic protocols, and reduce missed diagnoses and misdiagnoses.
Venous thromboembolism (VTE) consists of pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT). Lower extremity deep venous ultrasound is the non-invasive imaging modality of choice for the diagnosis of DVT, playing a pivotal role in identifying the etiology of PTE, guiding risk stratification, and informing treatment strategies. Within the framework of VTE prevention and management, lower extremity deep venous ultrasound enables the early screening of high-risk populations, assessment of thrombus characteristics (location, extent, stability), and monitoring of treatment response. However, standardized protocols for lower extremity deep venous ultrasound in the context of PTE are currently lacking in China, leading to significant inter-institutional variability in scanning protocols, operational techniques, thrombus staging criteria, and reporting standards. To address this gap, the consensus working group convened a multidisciplinary panel of experts in ultrasound medicine, respiratory medicine, vascular surgery, and evidence-based medicine. Based on a comprehensive review of the latest domestic and international evidence, and with due consideration of clinical feasibility and resource availability in China, this consensus systematically addresses key issues, including indications for ultrasound, scanning protocols, standardized procedures, thrombus stability assessment, staging criteria, and differential diagnosis. Fourteen recommendations are proposed to establish standardized protocols and a thrombus evaluation system for lower extremity venous ultrasound applicable to Chinese clinical practice, thereby improving the overall prevention and management of venous thromboembolism in China.
Tuberculosis (TB) remains a major global public health problem. According to the World Health Organization (WHO) Global Tuberculosis Report 2025, an estimated 10.7 million people developed TB and approximately 1.23 million died from the disease in 2024. China continues to face a high burden of both TB and multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). The introduction and expanded use of new and repurposed anti-tuberculosis drugs, including bedaquiline and linezolid, together with accumulating evidence supporting all-oral shorter regimens, have resulted in evidence-based uses that are not yet fully reflected in current Chinese prescribing information. Meanwhile, off-label doses, treatment durations, and alternative uses of established anti-tuberculosis drugs and repurposed anti-infective agents, including isoniazid, rifamycins, fluoroquinolones, and carbapenems, are common in patients with complex drug resistance, drug intolerance, or other special clinical conditions. Standardized guidance is therefore needed within evidence-based, legal, and safety-monitoring frameworks.Building on the Expert Consensus on Off-Label Use of Anti-Tuberculosis Drugs (2023 Update), the Tuberculosis Branch of the Chinese Medical Association developed this guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement. Focusing on 13 commonly used anti-tuberculosis drugs, the guideline systematically evaluates evidence regarding off-label indications, dosing, treatment duration, routes of administration, target populations, and safety monitoring. Comprehensive literature searches were conducted from database inception through June 10, 2025, and a total of 25 recommendations were formulated. Major updates in this guideline address newly approved and repurposed drugs and all-oral shorter regimens, optimized dosing and alternative applications of established agents, treatment considerations for children and patients with extrapulmonary tuberculosis, local drug administration, drug-safety monitoring, and therapeutic drug monitoring (TDM). The guideline aims to provide practical, standardized, and evidence-based recommendations to support the rational and safe off-label use of anti-tuberculosis drugs in clinical practice.The 25 recommendations are summarized as follows.Recommendation 1: Off-label use of anti-tuberculosis drugs should be supported by adequate medical evidence and limited to situations in which no appropriate approved alternative is available. Appropriate review and informed consent are required (1, B).Recommendation 2: An individualized safety monitoring plan should be developed according to drug-specific toxicities, patient characteristics, concomitant medications, and potential drug-drug interactions (1, B).Recommendation 3: High-dose isoniazid may be considered for patients with low-level isoniazid resistance and as a component of selected shorter regimens for MDR/RR-TB when isoniazid is likely to retain activity (2, C).Recommendation 4: Isoniazid, 10-15 mg/kg once daily, may be used for MDR/RR-TB with low-level resistance and retained activity (2, B). In selected cases of severe or refractory TBM, or when CNS exposure is inadequate, higher isoniazid dosing may be used; for children/adolescents, 15-20 mg/kg once daily with pyridoxine, toxicity monitoring, and TDM as needed (2, C).Recommendation 5: Local isoniazid administration may be cautiously and individually considered in selected cases as an adjunct to standardized systemic therapy, following specialist evaluation and appropriate safety monitoring (2, D).Recommendation 6: Where available, TDM may be considered for patients receiving high-dose isoniazid or those with an inadequate response, suspected malabsorption, clinically important drug interactions, a high risk of hepatotoxicity, or altered pharmacokinetics. NAT2 genotype-inferred acetylator phenotype may support individualized dose adjustment together with TDM, efficacy, and safety assessments (2, B).Recommendation 7: Off-label rifampicin use includes a 3-month regimen of isoniazid and rifampicin (3HR) (1, B) or a 4-month regimen of rifampicin (4R) (2, B) for tuberculosis preventive treatment; individualized high-dose use in TBM or investigational use in drug-susceptible pulmonary tuberculosis (2, C); local administration as adjunct therapy only (2, D); and use during pregnancy, including early pregnancy, after individualized benefit-risk assessment (2, C).Recommendation 8: Based on pharmacokinetic and safety data from Chinese populations, the 3H₂P₂ regimen-isoniazid 500-600 mg, plus rifapentine, 450-600 mg, twice weekly for 3 months-is recommended for tuberculosis preventive treatment (1, B).Recommendation 9: Levofloxacin is a key drug for fluoroquinolone-susceptible MDR/RR-TB (1, B); it may also be used for rifampicin-susceptible, isoniazid-resistant TB (2, D) or as an individualized alternative when first-line drugs cannot be used (2, C).Recommendation 10: Levofloxacin may be used in children of any age with MDR/RR-TB, and when first-line drugs cannot be used, as an individualized alternative for drug-susceptible TB. Dosing should be adjusted according to age and body weight, accompanied by appropriate safety monitoring (2, B).Recommendation 11: Oral levofloxacin administered once daily for 6 months is recommended for eligible close contacts of patients with MDR/RR-TB after active TB has been excluded and fluoroquinolone susceptibility of the source case has been assessed (1, B).Recommendation 12: Moxifloxacin may be used in fluoroquinolone-susceptible MDR/RR-TB (1, B). In drug-resistant TBM, individualized use may be considered, but 800 mg/day should not be routinely used (2, D). ECG and electrolyte monitoring is recommended during prolonged or high-dose use or concomitant QT-prolonging therapy (1, C).Recommendation 13: Fluoroquinolone TDM may be considered during high-dose or prolonged treatment or when drug exposure is uncertain. Levofloxacin Cmax 8-12 mg/L and moxifloxacin Cmax 3-5 mg/L are empirical reference ranges rather than fixed targets (2, B).Recommendation 14: Off-label linezolid use includes MDR/RR-TB, including pre-XDR-TB and XDR-TB (1, B); drug-resistant or refractory tuberculous meningitis (2, D); and eligible non-severe extrapulmonary MDR/RR-TB (2, C). Adults typically receive 600 mg once daily; children receive age-and weight-based dosing, with duration determined by the regimen (1, C).Recommendation 15: During prolonged linezolid treatment, monitoring should be performed for myelosuppression, optic and peripheral neuropathy, and lactic acidosis. The dose should be reduced, treatment interrupted, or linezolid discontinued according to toxicity severity, and concomitant serotonergic medications should be avoided whenever possible (1, B).Recommendation 16: TDM should be considered during prolonged linezolid treatment, particularly in patients with an inadequate response, serious toxicity, organ dysfunction, extreme body weight, or clinically important drug interactions (2, B).Recommendation 17: Contezolid may be considered as an alternative for patients with MDR/RR-TB who cannot tolerate linezolid or are at high risk of linezolid toxicity due to baseline myelosuppression, neurologic disease, or other factors, when an oxazolidinone is required to construct an effective regimen (2, D).Recommendation 18: Off-label clofazimine use includes longer MDR/RR-TB regimens as a WHO group B drug and selected 6-and 9-month regimens: its duration should follow the complete regimen and fluoroquinolone susceptibility results (1, B).Recommendation 19: Patients receiving clofazimine should be counseled regarding discoloration of the skin, mucosa, and body fluids and they should be monitored for gastrointestinal toxicity and Fridericia-corrected QT interval (QTcF) prolongation (1, B).Recommendation 20: Bedaquiline is a core drug for MDR/RR-TB. Off-label use includes adult RR-TB (2, C), children of any age with MDR/RR-TB (2, D), treatment beyond 24 weeks (2, C), use during pregnancy after benefit-risk assessment (2, C), and extrapulmonary MDR/RR-TB (2, C).Recommendation 21: During bedaquiline treatment, monitoring should be performed for QTcF prolongation, hepatic dysfunction, and other adverse reactions. More frequent ECG monitoring is recommended for older patients, those with underlying heart disease or electrolyte abnormalities, and those receiving concurrent QT-prolonging medications (1, B).Recommendation 22: Off-label delamanid use includes adult RR-TB as part of an appropriate combination regimen (2, C), children of any age with MDR/RR-TB (2, D), treatment extending beyond 24 weeks (2, C), use during pregnancy after benefit-risk assessment (2, C), and extrapulmonary MDR/RR-TB (2, C). Monitoring of QTcF interval, electrolytes, and serum albumin is required; its use should be avoided if the baseline serum albumin is <28 g/L (1, B).Recommendation 23: Amikacin may be considered for selected MDR/RR-TB, retreatment TB, or TB requiring regimen modification due to drug intolerance, and for severe, refractory, or drug-resistant TBM during the intensive phase (2, C). Local administration may be used as adjunctive therapy in selected cases (2, D).Recommendation 24: Monitor renal function, urinalysis, and auditory/vestibular function during amikacin treatment. Adjust the dose or dosing interval for renal impairment. TDM is advised when available, particularly for high-risk or prolonged treatment, to support individualized dosing (1, B).Recommendation 25: Meropenem or imipenem/cilastatin, each combined with clavulanate, may be considered as a Group C option for MDR/RR-TB when Group A and B drugs cannot form an effective regimen (2, D). In drug-resistant, severe, or refractory TBM, individualized use may be considered only when other effective options are unavailable; meropenem is preferred for children and patients at high risk of seizures (2, D).
The 2026 update of the Global Initiative for Asthma (GINA) further strengthens cough-related content in the diagnosis, differential diagnosis, and assessment of asthma. The major updates include refinement of cough-related asthma phenotypes, incorporation of induced sputum differential cell as a diagnostic method for asthma, inclusion of chronic cough-related etiologies in the differential diagnosis of asthma, and the integration of cough symptoms into asthma assessment. The expanded coverage of cough in the GINA 2026 update reflects the growing global attention to cough in asthma, and also highlights GINA's acknowledgment of research achievements from China in this field.
The prevalence of obstructive sleep apnea (OSA) is significantly increased in perimenopausal women. However, its symptoms overlap considerably with menopausal symptoms, leading to a very high underdiagnosis rate. Unrecognized OSA may exacerbate cognitive decline through intermittent hypoxia and sleep fragmentation. Recent studies have revealed a unique polysomnographic (PSG) "physiological fingerprint" in this population: predominance of hypopnea events, respiratory events highly concentrated in rapid eye movement (REM) sleep, a "high-frequency low-amplitude" hypoxic pattern, and sleep fragmentation with frequent microarousals. This characteristic profile is mechanistically linked to cognitive impairment: REM sleep disruption impairs emotional memory consolidation, frequent microarousals disrupt executive function and attention, and intermittent hypoxia constitutes the pathological basis of cognitive decline through oxidative stress and neuroinflammation. However, the current diagnostic framework based on the traditional apnea-hypopnea index (AHI) fails to capture the true disease burden, and targeted intervention strategies are lacking. This review aims to systematically summarize the PSG characteristics of perimenopausal women with OSA and their association with cognitive impairment, exploring multidimensional assessment approaches beyond AHI and individualized intervention pathways, thereby providing evidence-based guidance for early identification and precision management of this high-risk population.
Congenital unilateral absence of pulmonary artery (UAPA) is a rare congenital vascular malformation with diverse clinical manifestations and often challenging diagnosis. This article reports a case of a young male with hemoptysis as the main symptom. The uniqueness of this case lies in the previous history of patent ductus arteriosus (PDA) surgery and the confirmation of complete absence of the right pulmonary artery through computed tomography angiography (CTPA), with the right pulmonary artery being supplied by an independent abnormal vessel originating from the aortic arch. The significance of this case is that it not only presents an instance of rare UAPA with abnormal aortic arch blood supply, but also emphasizes that for patients with a history of congenital heart diseases such as PDA, when experiencing symptoms like hemoptysis, clinicians should actively broaden the differential diagnosis thinking and consider the possibility of previously hidden pulmonary vascular malformations. It also explores the potential mechanism by which the hemodynamic changes after PDA surgery may accelerate the pathological process of systemic collateral vessels and thereby induce hemoptysis, providing valuable references for understanding the clinical correlation of such diseases.
This report depicted a case of systemic air embolism caused by CT-guided percutaneous lung puncture and localization of pulmonary nodules, and reviewed the relevant literature. A 44-years-old male patient was scheduled to undergo minimally invasive surgery due to "pulmonary nodules found on physical examination", and preoperative CT-guided percutaneous lung puncture localization was performed. Sudden loss of consciousness and cardiac arrest were occurred in one minute after positioning of pulmonary nodules. Rapid CT revealed pericardial and left ventricular gas shadows, suggesting air embolism. The patient was immediately placed on his back and given cardiopulmonary resuscitation, transferred to the intensive care unit for advanced life support after successful resuscitation, and the patient's symptoms gradually improved, and the patient was discharged after stabilization. The occurrence of air embolism was related to the entry of gases into the blood circulation during the puncture, especially when the puncture path was close to the pulmonary vein branches. This case reminds clinicians to be highly vigilant for serious complications, such as air embolism, when performing lung puncture, and to strengthen postoperative monitoring and timely treatment to ensure patient safety.
Given their accessibility, cost-effectiveness, and scalability, digital health technologies (DHTs) are increasingly recognized as promising adjuncts to traditional smoking cessation approaches. To address the lagging evidence updates and lack of implementation pathways in existing guidelines, a multidisciplinary panel developed this guideline by systematically synthesizing current evidence on digital smoking cessation interventions. The development process adhered to the WHO Handbook for Guideline Development and the Chinese Principles for Developing/Revising Clinical Diagnosis and Treatment Guidelines (2022 Edition). The certainty of evidence and strength of recommendations were appraised utilizing the GRADE approach and the Evidence-to-Decision (EtD) framework. Ultimately, eight evidence-based recommendations were formulated for smokers aged ≥15 years with an intention to quit. The three strong recommendations and five conditional recommendations are as follows.Strong Recommendations (3 Items)1. Smartphone applications (Apps) are recommended as adjunctive tools for smoking cessation (1C). When selecting an App, priority should be given to those that incorporate professional psychological and behavioral interventions (1A).2. It is recommended that digital smoking cessation interventions, including short message service (SMS) or instant messaging (e.g., WeChat) (1B), smartphone Apps (1C), and artificial intelligence (AI) conversational systems (1B), be used in combination with traditional smoking cessation therapies (i.e., behavioral support and/or pharmacotherapy).3. When delivering digital smoking cessation interventions, multiple DHTs, including SMS or instant messaging (e.g., WeChat), web-based interventions, smartphone Apps, and AI conversational systems, should be integrated to construct a comprehensive digital smoking cessation platform. This platform should be seamlessly embedded within traditional smoking cessation services, routine clinical practice, and telemedicine systems to establish an integrated "online-plus-offline" collaborative care model (1C).Conditional Recommendations (5 Items)1. SMS or instant messaging (e.g., WeChat) is suggested as a supportive tool for smoking cessation (2B).2. Web-based interventions are suggested to serve as portals and adjunctive modules within a comprehensive digital smoking cessation system, used in combination with other DHTs (2D).3. AI conversational systems are suggested as adjunctive tools for smoking cessation support (2B).4. It is suggested that digital smoking cessation technologies (e.g., smartphone Apps and AI conversational systems) be developed in accordance with evidence-based clinical practice guidelines and psychological and behavioral change theories. These tools should emphasize interactivity and deliver phased, personalized interventions to enhance user adherence and cessation efficacy (2C).5. While digital smoking cessation interventions demonstrate a favorable safety profile, active monitoring of potential risks, particularly concerning mental health, data security, and healthcare resource allocation, is suggested during implementation (2C).This guideline systematically establishes standardized pathways for the development, clinical integration and application of digital smoking cessation interventions across various clinical and public health settings. It provides a robust evidence base to inform regulatory oversight and optimize resource allocation within comprehensive tobacco control frameworks. Ultimately, these recommendations aim to facilitate the appropriate adoption of DHTs for smoking cessation, thereby contributing to a reduction in population-level smoking prevalence and mitigating the global burden of tobacco-related diseases.
Bronchial asthma (asthma) is a common chronic inflammatory airway disease with a steadily increasing global disease burden. Current asthma management continues to face multiple challenges, including underdiagnosis, limited individualization of treatment strategies, poor long-term patient adherence, and insufficient accuracy in prognosis evaluation and risk prediction. In recent years, artificial intelligence (AI) technology has demonstrated unique advantages in the whole-course management of asthma. This article provides a systematic review of research progress in the application of AI to asthma diagnosis, assessment, treatment, and follow-up, aiming to offer new insights for further research and application of AI in the whole-course management of asthma.
Pneumoconiosis complicated with pulmonary tuberculosis is characterized by high prevalence and disability rates, as well as difficulty in early diagnosis, constituting a serious public health problem. The Chinese Society of Tuberculosis (Chinese Medical Association) and the Society of Labor Hygiene and Occupational Diseases (Chinese Preventive Medicine Association) organized multidisciplinary experts in respiratory diseases, occupational diseases, tuberculosis and other related fields to formulate the Chinese expert consensus on the diagnosis and treatment of pneumoconiosis complicated with tuberculosis. This consensus aims to enhance professional practitioners' understanding of the disease, improve the capacity for early clinical diagnosis, and further advance the prevention and treatment of pneumoconiosis complicated with pulmonary tuberculosis in China. It summarizes 12 key clinical issues and proposes 13 targeted recommendations to address difficulties and misconceptions in clinical practice. This consensus was registered on the International Practice Guidelines Registry Platform (PREPARE-2024CN271). It aims to enhance the standardized diagnosis and treatment of pneumoconiosis complicated by pulmonary tuberculosis, improve patient outcomes, and provide practical guidance for the prevention and control of occupational and infectious diseases in China. The main recommendations are as follows.Recommendation 1: Clinicians and pathologists are advised to pay attention to the mixed pathological features of pneumoconiosis complicated with pulmonary tuberculosis. For patients with pneumoconiosis presenting atypical imaging manifestations or poor response to conventional treatment, pathological specimens should be actively obtained to confirm the diagnosis. Combined use of acid-fast staining, Mycobacterium tuberculosis culture or molecular pathological detection is recommended to increase the detection rate (2C).Recommendation 2: When performing chest CT examinations and dynamic follow-up for pneumoconiosis patients, clinicians and radiologists should focus on multifocal and polymorphic lesions, as well as short-term imaging changes suggestive of active tuberculosis (2C).Recommendation 3: For patients with suspected pulmonary tuberculosis complicated with pneumoconiosis: (1) Be aware that sputum bacteriological tests may yield false-negative results due to dust interference. Repeated sampling or combined detection methods are recommended, including bacteriological and molecular tests on bronchoalveolar lavage fluid (BALF) obtained via bronchoscopy. Results of immunological assays such as the interferon-γ release assay (IGRA) and tuberculin skin test (TST)shall also be combined for comprehensive judgment. (2) In cases with atypical imaging findings and clinical symptoms, bronchoscopy-guided pathological sampling (e.g., EBUS-GS [endobronchial ultrasound with guide sheath], ENB [electromagnetic navigation bronchoscopy]) is prioritized. When microbiological evidence is insufficient, percutaneous lung biopsy or pleural biopsy (for patients with pleural effusion) is suggested to clarify the diagnosis (2B).Recommendation 4: The diagnosis of pneumoconiosis complicated with pulmonary tuberculosis shall follow the integrated diagnostic principle. Provided that patients meet the national diagnostic criteria for pneumoconiosis and pulmonary tuberculosis respectively, a comprehensive assessment shall be conducted combining occupational exposure history, dynamic imaging changes and laboratory results. Patients shall be stratified for managementaccording to the activity of tuberculosis (2C).Recommendation 5: For differential diagnosis between pneumoconiosis complicated with pulmonary tuberculosis and non-tuberculous mycobacterial (NTM) lung disease: (1) NTM lung disease commonly involves the apical and anterior segments of the upper lobes, the right middle lobe and the lingular segment of the left upper lobe. Typical imaging manifestations include a combination of centrilobular nodules and bronchiectasis. (2) Multiple thin-walled cavities are frequently seen in silicosis complicated with NTM lung disease. (3) Pathologically, NTM lesions are dominated by epithelioid granulomas with inconspicuous caseous necrosis. (4) Definitive diagnosis relies on mycobacterial culture and species identification, complying with combined clinical, imaging and microbiological criteria (2C).Recommendation 6: For patients with pneumoconiosis complicated with pulmonary tuberculosis who present progressively enlarged cavities or newly developed cavities accompanied by aggravated symptoms after anti-tuberculosis treatment, radiologists shall evaluate imaging signs of pulmonary aspergillosis, such as the early halo sign and the late air crescent sign within cavities (2C).Recommendation 7: For patients with suspected pneumoconiosis complicated with pulmonary aspergillosis: (1) Bronchoscopy is performed to collect BALF or tissue specimens for fungal culture and pathological examination (gold standard). (2) Conduct BALF galactomannan (GM) test, metagenomic next-generation sequencing (mNGS) or other DNA detection assays. (3) Detect serum specific antibodies against Aspergillus fumigatus (e.g., IgE-m3, IgM) (1A).Recommendation 8: For patients with pneumoconiosis complicated with drug-susceptible pulmonary tuberculosis: (1) Adopt the standard first-line four-drug anti-tuberculosis regimen. (2) Ensure a sufficient treatment course (generally ≥6-8 months). (3) Extend the treatment course to≥9-12 months for patients with severe lesions or concomitant tracheal, pleural or extrapulmonary tuberculosis, so as to improve clinical outcomes and reduce recurrence (2A).Recommendation 9: For patients receiving concurrent treatment for pneumoconiosis (including tetrandrine, nintedanib, pirfenidone, glucocorticoids, bronchodilators, etc.) and rifampicin-containing anti-tuberculosis regimens: (1) Be aware that rifampicin, a potent hepatic enzyme inducer, may accelerate the metabolism of concomitant drugs such as glucocorticoids and nintedanib and reduce their efficacy. (2) Adjust the dose of affected drugs accordingly when rifampicin is initiated or discontinued (1B).Recommendation 10: Extracorporeal membrane oxygenation (ECMO) may be used as a bridge to lung transplantation only for end-stage pneumoconiosis patients complicated with pulmonary tuberculosis awaiting transplantation (2D).Recommendation 11: For end-stage patients with pneumoconiosis complicated with pulmonary tuberculosis who have received adequate and standard anti-tuberculosis therapy, the feasibility of lung transplantation shall be evaluated. Pre-transplant precautions: (1) Ensure complete control of active tuberculosis. (2) Optimize the anti-tuberculosis regimen (e.g., replace rifampicin with rifabutin) to maintain the effective concentration of immunosuppressants (2D).Recommendation 12: For patients with severe, end-stage pneumoconiosis complicated with pulmonary tuberculosis who no longer benefit from active treatment, palliative care and hospice care shall be initiated. Clinicians and medical teams shall communicate fully with patients and their families about the condition, prognosis, treatment options and medical burden. The core goals are to relieve symptoms, alleviate suffering and improve quality of life (2D).Recommendation 13: For patients with pneumoconiosis complicated with tuberculosis who meet the indications for surgical or interventional therapy, a multidisciplinary team shall conduct joint decision-making and implement treatment in a timely manner after full assessment of pulmonary function, nutritional status and surgical risks. Surgical treatment is mainly indicated for patients with drug-resistant tuberculosis with localized lesions, persistent cavitary lesions with ongoing mycobacterial excretion, destroyed lung, massive hemoptysis unresponsive to medical treatment, tuberculous empyema and other critical conditions. Interventional therapy can be applied for emergency treatment of massive hemoptysis, as well as palliative treatment for pulmonary artery stenosis secondary to tuberculosis or pneumoconiosis (2C).
We reported a case of extremely severe tuberous sclerosis complex-associated lymphangioleiomyomatosis (TSC-LAM) involving the brain, liver, kidneys, and lungs that was successfully treated with sirolimus, with a complete 17-year follow-up. The patient was diagnosed in 2008 and experienced rapid progression; by 2012, the patient had developed respiratory failure, severe anemia, renal insufficiency, and extreme abdominal distension. After 3 days of treatment with sirolimus, the aforementioned symptoms improved significantly, and respiratory failure resovled. Over the following 7 years of regular maintenance therapy, lung function declined only slightly each year, and the 6-minute walking test(6MWT) showed no decline. However, after sirolimus was discontinued from January 2020 to April 2021, the patient's lung function and 6MWT declined rapidly, with concurrent development of pneumothorax. Although sirolimus was subsequently resumed and remained effective, with no recurrence of pneumothorax or chylothorax, parameters such as lung function and 6MWT still did not recover significantly. This case suggests that TSC-LAM requires long-term maintenance therapy with sirolimus. Abrupt discontinuation of treatment may lead to rapid clinical deterioration.
Objective: To summarize the clinical features, imaging findings, and diagnostic and therapeutic experience of adult patients with congenital pulmonary vein atresia (CPVA), in order to improve clinicians' awareness of this rare disease. Methods: The clinical data of 2 adult patients initially diagnosed with CPVA in our hospital were retrospectively analyzed. In combination with literature retrieved from PubMed and Web of Science up to June 2025, we performed a pooled analysis of CPVA cases diagnosed at age ≥18 years. A total of 30 cases from 27 articles were included; together with 2 cases, a total of 32 cases were analyzed. Their clinical manifestations, imaging characteristics, treatment, and prognosis were summarized. Results: Both of our 2 patients were female, aged 24 and 68 years. Case 1 presented with cough and blood-streaked sputum during pregnancy, with symptom relief after delivery; imaging revealed absence of the right pulmonary veins and a right aortic arch. Case 2 presented with chronic cough and was found to have right upper pulmonary vein atresia with collateral circulation. Among the 32 pooled patients, the median age at diagnosis was 25 years. The main symptoms were hemoptysis (13 cases), dyspnea (11 cases), and cough with sputum (6 cases); 5 cases were asymptomatic. Unilateral involvement occurred in 24 cases (right 16, left 8). Conservative treatment was given in 16 cases, and pneumonectomy in 8 cases. Most patients improved after conservative or surgical treatment, with only 1 death due to postoperative complications. On imaging, CPVA often manifested as non-visualization of the affected pulmonary veins, interstitial lung changes, and systemic-to-pulmonary collaterals, and was easily misdiagnosed as interstitial lung disease or infectious lesions. Conclusion: Although CPVA is rare in adults, some cases can be well compensated and remain undiagnosed until adulthood or even old age. The clinical manifestations are nonspecific, and imaging examinations often provide the first clue to diagnosis; therefore, vascular malformations should be considered in the differential diagnosis of unilateral pulmonary lesions. Treatment should be individualized: conservative follow-up is suitable for asymptomatic or mild cases, whereas surgery or interventional therapy may be considered for those with massive hemoptysis or severe symptoms.
Objective: To preliminarily evaluate the efficacy and safety of sotatercept in patients with pulmonary arterial hypertension (PAH) in China. Methods: This single-center, retrospective case series analysis included seven consecutive PAH patients treated at Ruijin Hainan Hospital, Shanghai Jiao Tong University School of Medicine, who received sotatercept in addition to stable background therapy from May to December 2025. Key efficacy indicators included 6-minute walk distance (6MWD), World Health Organization functional class (WHO FC), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and systolic pulmonary artery pressure (PASP). The core safety indicators were the dynamic changes in hemoglobin (Hgb) and platelet count (PLT). Results: Of the seven patients treated with sotatercept, one received only a single dose and discontinued for personal reasons, and was therefore excluded from subsequent analysis. The remaining six patients completed one-month follow-up, with three completing both one-and three-month follow-ups. At one month, 6MWD significantly improved in five of six patients (5/6), with further improvement in two of three patients (2/3) at three months. At the one-month follow-up, NT-proBNP significantly decreased in five of six patients (5/6) compared to baseline, with further reduction in one of three patients (1/3) at the three-month follow-up. At the three-month follow-up, echocardiographic estimates of pulmonary artery pressure decreased in two of three patients (2/3), and WHO FC improved in two of three patients (2/3). Among the six patients, one (1/6) had a delayed sotatercept dose due to an excessive increase in hemoglobin, and one developed a decrease in platelet count; no other adverse reactions occurred. Conclusions: Sotatercept demonstrated significant short-term improvements in cardiac function and exercise capacity in Chinese PAH patients, with a manageable safety profile. However, due to the small sample size and short follow-up period, these findings require further validation through large-scale, long-term prospective studies.
Lung cancer associated with cystic airspaces (LCCA) is a rare and distinct subtype of lung cancer. Patients are often without specific clinical symptoms in the early stage, and the radiological features can be easily confused with pulmonary bullae, benign pulmonary cysts, and other cystic lung lesions, resulting in a high rate of missed diagnosis and misdiagnosis. We report the case of a middle-aged woman with LCCA pathologically confirmed following surgical resection. A chest computed tomography (CT) scan performed during a routine health examination initially revealed an air-containing lesion adjacent to the oblique fissure in the right lower lobe, measuring approximately 1.1 cm×0.8 cm. Serial CT examinations over a 12-year period demonstrated gradual evolution of the lesion, with the development of a lobulated contour, interlobar pleural indentation, and vascular convergence, raising suspicion for malignancy. The patient subsequently underwent surgical resection. Based on histopathological and immunohistochemical findings, the lesion was finally diagnosed as invasive lung adenocarcinoma (lepidic predominant, 60%; acinar, 30%; papillary, 10%). No evidence of tumor recurrence or metastasis was observed during postoperative outpatient follow-up.
Respiratory diseases are diverse and complex, and even the same disease may exhibit heterogeneity. Current treatments are often hampered by limited efficacy and insufficient targeting. In recent years, regenerative therapies have gradually gained attention, and stem cell-based therapies have shown potential in respiratory diseases. However, their basic research clinical validation, and translational pathways remain to be further explored. This review outlines the classification of stem cells, their mechanisms of action, research progress in various respiratory diseases, as well as future challenges and perspectives. It aims to summarize the current status and potential value of stem cell-based therapies in respiratory diseases and to inform related basic, clinical, and translational research.
