Background: Hemoptysis is a potentially life-threatening respiratory emergency that requires prompt evaluation and management. Bronchial artery embolization (BAE) is currently regarded as the first-line treatment for massive and recurrent hemoptysis because of its high technical and clinical success rates, minimally invasive nature, and favorable safety profile. The aim of this retrospective study was to evaluate the technical and clinical outcomes of bronchial artery embolization in patients presenting with hemoptysis, including procedure-related complications and recurrence during follow-up. Methods: A single-center, retrospective, observational study was conducted. Thirty-five consecutive adult patients (37 procedures) who underwent BAE for hemoptysis between January 2018 and April 2026 were identified. Immediate outcomes were analyzed in all patients, whereas follow-up outcomes were analyzed in the 30 patients (32 procedures) with available follow-up data. Clinical, imaging, procedural, and follow-up data were collected from electronic medical records and the Picture Archiving and Communication System (PACS). Technical success (per procedure) was defined as embolization of all angiographically identified target arteries with achievement of the angiographic endpoint, and clinical success (per patient) as complete cessation or significant reduction in hemoptysis within 48 h after the index BAE, sustained until discharge; persistent bleeding or rebleeding before discharge was classified as clinical failure. Recurrence of hemoptysis was assessed separately during follow-up and was defined as any new episode of hemoptysis occurring after discharge in patients with initial clinical success, regardless of severity or the need for repeat embolization. Results: Technical success was achieved in all 37 procedures (100%) and clinical success in 34/35 patients (97.1%); the remaining patient underwent successful repeat BAE during the index hospitalization. Procedure-related adverse events occurred after 2/37 procedures (5.4%) and consisted of transient chest pain due to non-target embolization of Onyx into intercostal branches (CIRSE grade 1); no major complications occurred. In the 30 patients with follow-up (median 14.6 months), recurrent hemoptysis occurred in 3 (10.0%), all within the first year, and one (3.3%) required repeat BAE. Conclusions: In this single-center retrospective series, BAE, performed predominantly with liquid embolic agents, was associated with high technical and clinical success and a low rate of minor procedure-related complications. These findings are descriptive and hypothesis-generating. Because of the retrospective design, small sample size, attrition, heterogeneous etiologies, and absence of a comparator group, no conclusions on comparative effectiveness can be drawn. Larger prospective multicenter studies are needed.
Successful tuberculosis (TB) treatment does not necessarily restore pulmonary health, and many TB survivors develop persistent structural and functional lung abnormalities known as post-tuberculosis lung disease (PTLD). Despite its clinical significance, the mechanisms underlying PTLD remain poorly understood, and effective therapies are lacking. Progress is impeded by the absence of preclinical models that adequately reproduce post-treatment features of pulmonary TB. This narrative review evaluates established animal TB models, such as murine, guinea pig, rabbit, and non-human primate models, and their relevance to PTLD research. We assessed their ability to replicate lung pathology, such as fibrosis, cavitation, extracellular matrix remodeling, and persistent inflammation. Additionally, we examined the mechanisms of TB-associated lung injury, including immune dysregulation, matrix metalloproteinase activity, and profibrotic signaling. However, these pathological processes have been studied predominantly during active infection, and their contributions to persistent lung damage following treatment remain insufficiently characterized in existing preclinical models. Major translational gaps include limited emphasis on post-treatment disease, inadequate longitudinal assessment of lung function, and the absence of standardized criteria for defining PTLD in preclinical studies. Finally, we underscore the need for longitudinal animal models incorporating treatment outcomes and clinically relevant endpoints to bridge experimental findings with the persistent pulmonary consequences experienced by TB survivors.
Rationale: Nasal nitric oxide (nNO) measurement is a recommended noninvasive screening tool for primary ciliary dyskinesia (PCD), but studies examining its real-world performance are limited, and integration of PCD diagnostic pathways varies across centers. Objective: The objective of this study was to evaluate the diagnostic utility of nNO, describe phenotypic profiles of patients with low and normal NO levels, and highlight the existing challenges in diagnosing PCD. Methods: We assessed the diagnostic performance of nNO testing in patients with suspected PCD, known PCD, or bronchiectasis/bronchiolitis with no known etiology who underwent nNO measurement using the velum closure technique between January 2023 and May 2025. We recorded and analyzed baseline clinical features, pulmonary function testing values, microbiologic data, and available genetic and other PCD diagnostic testing results. Results: Among 86 patients (mean age 30.4 ± 18.96 years; 61.6% female), 24 (27.9%) had low nNO (<77 nL/min) and 62 (72.1%) had normal nNO (≥77 nL/min). Of the 24 individuals with low nNO, 17 (70.8%) were confirmed to have PCD through genetic and/or electron microscopy testing. Of the 62 with normal nNO, 2 were confirmed to have PCD via genetic analysis; both had nNO < 100 nL/min. nNO testing supported the diagnosis of PCD in 6 of 19 cases (31.6%) with newly diagnosed PCD. Patients with low nNO had lower Forced Expiratory Volume in 1 s (FEV1) percent predicted (72.2 ± 23.0% vs. 84.5 ± 22.0%, p = 0.04) and had higher rates of Pseudomonas aeruginosa (54.2% vs. 25.8%, p = 0.02) compared with those with normal nNO. Conclusions: nNO testing performs well in the diagnostic evaluation of PCD among patients with clinical phenotypes suspicious for PCD. Substantial heterogeneity in the extent of PCD genetic testing was observed, underscoring the need to better define which patients may benefit from expanded PCD diagnostic evaluation or whole-genome sequencing (WGS). As there is no gold-standard diagnostic test for PCD, there is a need for further studies to refine diagnostic algorithms.
Background and Purpose: As the workforce ages, facilitating the integration of medical care and occupational activities is a key concern for individuals with chronic obstructive pulmonary disease. Although dyspnea is associated with reduced work productivity, the relationship between employment status and the effects of pulmonary rehabilitation remains unclear. This study examined whether changes in exercise capacity and dyspnea following pulmonary rehabilitation differed according to employment status in individuals with chronic obstructive pulmonary disease. Methods: This exploratory prospective cohort study included 34 individuals with chronic obstructive pulmonary disease who participated in a 3-month outpatient pulmonary rehabilitation program. Participants were classified as employed (n = 6) or unemployed (n = 28). To evaluate changes following pulmonary rehabilitation, a two-way repeated-measures analysis of covariance (ANCOVA) was performed. Time (pre- and post-intervention) was treated as a within-subject factor, while employment status served as a between-subject factor, with age incorporated as a covariate. The primary endpoints were functional exercise capacity, evaluated using the 6 min walk distance, and dyspnea severity, assessed using the modified Medical Research Council scale. Results: For functional exercise capacity, neither the time × employment status interaction nor the main effect of time was statistically significant (p = 0.165 and p = 0.062, respectively). For dyspnea, the time × employment status interaction was not statistically significant (p = 0.567), whereas a significant main effect of time (p = 0.020) and a significant time × age interaction (p = 0.014) were observed. Exploratory within-group comparisons did not detect significant changes in either employment group. Discussion: No statistically significant differences in changes in exercise capacity or dyspnea were detected between employment groups. The significant main effect of time for dyspnea should be interpreted in light of the significant time × age interaction. Given the small and markedly unequal group sizes, particularly the limited number of employed participants, these findings should be regarded as exploratory and hypothesis-generating. Larger prospective studies are required to determine whether employment-related factors modify responses to pulmonary rehabilitation.
Background/Objectives: Primary ciliary dyskinesia (PCD) caused by biallelic RSPH4A variants is enriched in the Puerto Rican population due to the founder allele c.921+3_921+6delAAGT, a 4-nucleotide deletion affecting the intron 6 splice donor. This study aimed to characterize the genotype–computed tomography (CT) phenotype associated with homozygosity for this founder variant and examine relationships among age, pulmonary function, and structural lung disease. Methods: We performed a cross-sectional analysis of 20 genetically confirmed patients homozygous for RSPH4A c.921+3_921+6delAAGT. Demographic characteristics, spirometry, and chest CT findings were evaluated. Structural disease burden was quantified using a Bhalla-style CT severity score, and regression analyses assessed associations among age, CT severity, sex, and forced expiratory volume in 1 s (FEV1). Results: Mean FEV1 was 48.9% predicted (range, 26–65%) and showed no measurable association with age (slope −0.02% per year; 95% CI, −0.26 to +0.22; p = 0.88). Bronchiectasis was multilobar, with right-middle-lobe involvement in 80% of patients. CT severity showed a modest cross-sectional increase with age, whereas FEV1 remained relatively stable across age groups. In multivariable analysis, greater CT severity showed the strongest association with lower FEV1 (β = −0.56% per CT point; 95% CI, −1.13 to +0.01; p = 0.07), although this association did not reach statistical significance. Conclusions: In this Puerto Rican RSPH4A founder cohort, substantial airflow obstruction was observed across the age spectrum, while structural CT abnormalities were greater in older patients despite relatively stable FEV1. This cross-sectional dissociation suggests that spirometry alone may incompletely reflect structural disease burden. These findings support the complementary role of CT imaging in phenotypic characterization and longitudinal assessment of RSPH4A-related PCD and provide a rationale for earlier identification and future longitudinal studies.
