Transitioning from selexipag to parenteral prostacyclin analogues yielded haemodynamic improvement. Outcomes are poor among those within this population who do not achieve a low-risk status after the transition. https://bit.ly/4sMY3aF.
Background:Breathlessness is a common symptom in long COVID (LC). Using hyperpolarised xenon magnetic resonance imaging (129Xe-MRI), we assessed whether this symptom could be attributed to abnormalities in the alveolar-capillary membrane not detected by standard investigations. We focused on never-hospitalised individuals without an identified cause for breathlessness. Methods:In this prospective, multicentre study, we compared 129Xe-MRI, lung function, exercise capacity and symptom questionnaires in LC patients with breathlessness (BLC) to those without breathlessness (NBLC) and healthy controls. Primary outcome was whether BLC demonstrated measurable impairments in gas exchange focusing on dissolved-phase 129Xe-MRI metrics: red blood cell to membrane ratio (RBC:M) and red blood cell to gas ratio (RBC:Gas). We also explored associations between symptoms and physiological measures. Results:Of 269 participants recruited, 196 were included in the analysis (109 BLC, 43 NBLC, 44 controls), with age and sex well matched across groups. BLC had a significantly longer interval from infection to MRI (median 632 days; p<0.001). No significant differences in global or regional RBC:M or RBC:Gas were observed across groups. BLC showed lower forced expiratory volume in 1 s, forced vital capacity, transfer factor of the lung for carbon monoxide (T L CO), and carbon monoxide transfer coefficient (K CO) z-scores compared to controls, though >90% of values remained within normal range. A subset of BLC participants with low T L CO (14 out of 109) showed reduced 129Xe-MRI metrics and higher breathlessness scores. Interpretation:Most nonhospitalised LC participants exhibited no detectable pulmonary abnormalities, including those with breathlessness. However, ∼13% of breathless individuals demonstrated minor reductions in T L CO and 129Xe-MRI gas exchange suggesting a potential pulmonary contribution for symptoms in this subgroup.
Beyond detecting obstruction and pathogens, bronchial lavage aids inflammatory phenotyping and risk stratification, especially in nonsputum, early-stage and TB-endemic cases where excluding active TB is crucial https://bit.ly/47AdhYS.
Pleural plaques are frequent in Iceland and independently associated with interstitial lung abnormalities, highlighting the persistent threat of asbestos-related disease and stressing the urgent need for continued monitoring https://bit.ly/4u4riGW.
Think bronchoscopy is just for samples? Think again. It impacts clinical management in >50% of bronchiectasis cases with a high safety profile: moving from expert opinion to data-driven care. https://bit.ly/3NYVAM3.
Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could result in pulmonary vascular injury, systemic inflammation, and endothelial dysfunction, which could increase future risk of pulmonary hypertension (PH) and related complications. Methods:We conducted a retrospective cohort study from the Montefiore Medical Center (Bronx, NY, USA) (1 March 2020 to 17 August 2024). Patients who had a COVID-19 PCR test were compared to those who did not have a positive COVID-19 PCR test on record. There were 15 721 hospitalised COVID-19 patients, 43 740 non-hospitalised COVID-19 patients, and 870 458 contemporary COVID-negative controls, and 634 892 historical (1 May 2016 to 31 December 2019) controls. The main analysis used propensity score matching for demographics, tobacco, substance use disorder, vaccination for SARS-CoV-2, and pre-existing comorbidities. New-onset PH and PH-related complications were assessed using Fine-Gray subdistribution hazard ratios (sHR). Sensitivity analyses included multivariable cause-specific Cox proportional hazard model, inverse probability weighting, and using matched historical cohort as controls. Long-term PH-related complications included heart failure, chronic kidney disease, and all-cause mortality compared to matched controls. Blood biomarkers during acute COVID-19 were analysed with respect to new-onset PH. Results:Compared to propensity-matched COVID-negative controls, COVID-19 hospitalised patients were (sHR) 1.41 (95% CI 1.27-1.57) times more likely to experience new-onset PH, and COVID-19 non-hospitalised patients were 1.42 (95% CI 1.25-1.61) times more likely to do so. Sensitivity analyses corroborated our main findings. Among those with new-onset PH, only hospitalised COVID-19 survivors had higher risks of subsequent heart failure (sHR 1.61, 95% CI 1.11-2.35), chronic kidney disease (2.18, 1.50-3.16), and all-cause mortality (1.81, 1.47-2.24) compared to matched controls. Abnormal troponin (sHR 1.61, 95% CI 1.05-2.48), brain natriuretic peptide (1.59, 1.20-2.11) and creatinine (1.24, 1.01-1.51) during acute COVID-19 were associated with outcomes, but not D-dimer, ferritin and haematological markers. Conclusions:SARS-CoV-2 infection is independently associated with elevated long-term risk of new-onset PH, whereas only hospitalised COVID-19 status is associated with higher risk of downstream PH-related complications. These findings underscore the importance of ongoing PH surveillance in COVID-19 survivors.
Introduction:Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) has demonstrated efficacy in people with cystic fibrosis (pwCF) aged ≥6 years with ≥1 F508del allele in clinical trials. This registry-based cohort study aimed to describe real-world use and outcomes up to 36 months post-treatment initiation among pwCF aged ≥6 years treated with ELX/TEZ/IVA in France. Methods:Outcomes included per cent predicted forced expiratory volume in 1 s (ppFEV1), intravenous-treated pulmonary exacerbations (PEx), hospitalisations, nutrition, lung transplantation, mortality and, among pwCF ≥18 years, quality of life (CFQ-R). All results are presented by population (≥12 years and 6-11 years). In the ≥12 years cohort, a subgroup analysis of pwCF with advanced lung disease (ALD), defined as ppFEV1 <40% at baseline, is presented. Results:The study included 553 pwCF aged 6-11 years, with a mean±sd age of 8.8±1.9 years at baseline, ppFEV1 of 91.3±17.6% and mean follow-up of 8.9 months. In addition, 3313 pwCF aged ≥12 years were included, with a mean±sd age at baseline of 27.6±11.7 years, ppFEV1 of 65.4±24.8% and mean follow-up of 21.2 months. In the cohort aged 6-11 years, ppFEV1 improved by +9.6% (95% CI: 7.6-11.6) at 12 months and i.v.-treated PEx annual rate decreased from 0.15 (95% CI: 0.11-0.18) to 0.02 (0.00-0.04) after 0 to 12 months post-ELX/TEZ/IVA initiation. Among pwCF ≥12 years ppFEV1 improved post-ELX/TEZ/IVA initiation by +16.2% (95% CI: 15.6-16.8) at 24 months. i.v.-treated PEx annual rate decreased from 0.92 (95% CI: 0.88-0.95) during baseline to 0.14 (95% CI: 0.12-0.15) after 12 to 24 months post-ELX/TEZ/IVA initiation. Similar benefits to those in the ≥12 years population were observed in the ALD subgroup. Conclusion:This study confirms the longer term, transformational clinical benefit of ELX/TEZ/IVA in pwCF aged ≥6 years in a French population, demonstrating sustained improvements across multiple health outcomes, including in pwCF with ALD that were not part of the pivotal clinical trials.
Background:Fractional exhaled nitric oxide (F ENO) reflects type 2 airway inflammation, yet the prognostic utility of longitudinal F ENO changes in COPD remains unclear. We aim to explore whether 6-month F ENO variation patterns predict subsequent moderate-to-severe exacerbations in COPD patients receiving triple therapy. Methods:We prospectively evaluated COPD patients receiving triple inhaled therapy from 2023 to 2024. Four F ENO-related variables were used to derive F ENO variation phenotypes via K-means unsupervised clustering. Results:Three distinct F ENO-variation phenotypes were identified: a High F ENO-Persistently Elevated subtype (Cluster 1, 11.2%), a High F ENO-Declining subtype (Cluster 2, 20.3%) and a Low F ENO-Stable subtype (Cluster 3, 68.5%). During 6-12 months of follow-up, 75 patients (33.8%) experienced a moderate-to-severe exacerbation. Compared with Cluster 3, both Cluster 1 (OR 6.97, 95% CI 2.38-20.47) and Cluster 2 (OR 20.08, 95% CI 7.01-57.58) were independently associated with future exacerbations (p<0.001). The final prediction model incorporating F ENO variation phenotypes demonstrated excellent discrimination (AUC 0.889) and provided greater net clinical benefit than models using traditional clinical predictors alone (p=0.004). Subgroup analyses revealed consistent effect sizes across categories of age, prior-year exacerbations, baseline FEV1 % predicted, symptom burden, smoking status and proportion of days covered, supporting the robustness and internal consistency of the F ENO-variation phenotyping approach. Conclusion:Short-term longitudinal F ENO variation over 6 months was independently associated with future moderate-to-severe exacerbations in COPD patients receiving triple therapy, supporting risk stratification and hypothesis generation for future interventional studies rather than direct treatment guidance.
Objective To investigate whether the association between diet and lung function (LF) differs according to asthma or COPD status in the Lifelines cohort study. Methods We included adults from Lifelines with valid dietary and spirometry data. Dietary quality was calculated at baseline using the Lifelines diet score (LLDS) (range 0–48, where higher scores indicate a healthier diet). LF was assessed via pre-bronchodilator spirometry (forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC) at baseline and two follow-ups (∼10 years). Cross-sectional associations between diet and LF were examined using linear regression and longitudinal associations with linear mixed-effects models. Interactions between diet and asthma or COPD were included. Results Higher LLDS was associated with higher LF and slower decline. In cross-sectional analyses (n=83 460, 59% female, mean age 44±13 years), higher LLDS was associated with higher FEV 1 and FEV 1 /FVC levels in participants with asthma (FEV 1 β interaction (β int )=2.48 mL, 95% CI 0.68–4.27; FEV 1 /FVC β int =0.027%, 0.003–0.052) and COPD (FEV 1 β int =8.31 mL, 6.93–9.69; FEV 1 /FVC β int = 0.094%, 0.079–0.109) compared with those without asthma or COPD. In longitudinal analyses (n=37 752, 59% female, age 46±11 years) in COPD-patients higher LLDS was associated with slower FEV 1 decline (β int =0.18 mL·yr −1 , 0.04–0.33), FVC (β int =0.23 mL·yr −1 , 0.04–0.41) and FEV 1 /FVC (β int =0.002%·yr −1 , 0.000–0.005) compared with those without COPD. Conclusions Higher diet quality was associated with better LF, particularly in those with asthma or COPD, and with slower decline in participants with COPD. These findings suggest that diet may be a modifiable factor in respiratory health.
Antimicrobial resistance (AMR) is an escalating global health threat. Chronic lung diseases (CLDs) represent a key area in which AMR poses unique and often underestimated challenges, yet high-quality epidemiological data remain scarce. To address this gap, the European Respiratory Society Clinical Research Collaboration on AMR in Lung Infections (AMR-Lung CRC) has developed PRESIDE, an international prospective observational registry designed to evaluate the prevalence and burden of AMR in patients with CLD. PRESIDE is a global, multicentre study recruiting paediatrics and adults with CLD who have undergone respiratory microbiological testing as part of routine clinical care within the year prior to data collection. Participating centres enroll patients during two-week recruitment periods, held twice yearly over five years from 2025 to 2030. The registry captures a comprehensive set of core variables, including demographics and smoking history, CLD type and aetiology, microbiological history, comorbidities, clinical characteristics, therapeutic exposures, and respiratory microbiology results. This registry aims to generate robust, prospective, real-world evidence on AMR epidemiology in CLD, enabling comparison across regions and disease phenotypes. Findings are expected to inform clinical decision-making, support antimicrobial stewardship, and guide the development of context-specific guidelines and public health strategies. Ultimately, PRESIDE seeks to strengthen global efforts to address AMR in chronic respiratory infections and improve outcomes for patients with CLD.
Background Current data suggest that the incidence of pleural infection is rising worldwide, however mortality data on global rates, trends and variations are lacking. Objectives To estimate pleural infection mortality rates across 24 Countries from 1994 to 2020 worldwide, using death certificates data from the World Health Organization (WHO) mortality database. Methods We extracted country-level mortality data for pleural infection (International Classification of Diseases 10th Edition, ICD-10, codes “J86.0”, “J86.9”) from the WHO dataset. We calculated sex-specific age-standardised mortality rates for the quinquennia 2005–2009 and 2015–2019 using direct standardisation. Joinpoint regression analysis was used to assess temporal trends. Results Average yearly deaths approximately a 30% between 2005–2009 and 2015–2019. Mortality rates were 2.7-fold higher in males than females across both periods. The highest mortality rates in 2015–2019 were observed in South Africa (males 3.12; females 1.00 per 1 000 000), Argentina (males 2.61; females 1.09), and Brazil (males 3.05; females 1.21). Germany (AAPC +8.00% males; +5.57% females) and the USA (AAPC +3.55% females) demonstrated the greatest temporal increases, whereas France, Spain, and South Africa showed significant decreasing trends. Conclusion Pleural infection mortality rates remain low globally but demonstrate substantial international variation, consistent male predominance, and divergent temporal trends. These findings highlight the need for standardised case definitions and further investigation of factors underlying regional differences.
Background Low-dose computed tomography (LDCT) screening reduces lung cancer mortality through early detection. However, lung cancer screening uptake among high-risk groups remains low and varies by setting. This study aims to assess the factors associated with LDCT screening uptake among high-risk individuals. Methods We searched Medline (Ovid), Embase (Ovid), and Scopus for observational studies and randomized controlled trials of high-risk individuals published up to May 31, 2026. Random-effects models estimated pooled odds ratios (ORs) for LDCT uptake among high-risk individuals, with subgroup, sensitivity, publication bias, and risk of bias assessments. Results Of 9117 publications, 61 met the inclusion criteria. Pooled overall LDCT uptake was 39.5% (95% CI: 33.2%–46.1%), with higher uptake in the UK (91.3%) than China (39.8%) and the US (33.2%). Screening uptake was lower among current smokers (OR=0.88, 95% CI: 0.79–0.97), those living in rural areas (OR=0.89, 95% CI: 0.82–0.96), and the least affluent (OR=0.85, 95% CI: 0.74–0.98), while it was higher among those with health insurance group (OR=2.96, 95% CI: 2.35–3.74), those with COPD (OR=1.85, 95% CI: 1.42–2.41), and those with a family history of lung cancer (OR=1.67, 95% CI: 1.48–1.88). Sensitivity analyses indicated robustness, with an overall low-to-moderate risk of bias. Conclusion Smoking, living in rural areas, and deprivation were associated with lower uptake, while health insurance, COPD, and family history of lung cancer were associated with higher uptake. High study heterogeneity warrants cautious interpretation. Lung cancer screening campaigns should target smokers, rural residents, and less affluent individuals to reduce disparities. Future research should include low- and middle-income countries.
Background:Chronic airway dysbiosis plays an important role in the pathogenesis of cystic fibrosis (CF) lung disease and may serve as a therapeutic target. However, studies investigating the effects of direct therapeutic targeting of the airway microbiome are lacking. In this study, we therefore used βENaC-overexpressing (βENaC-Tg) mice and determined the evolution of abnormal lung microbiota and effects of re-balancing bacterial communities on chronic airway inflammation and mucus plugging in this model of CF lung disease. Methods:The development of the respiratory microbiome was determined by 16S rRNA gene sequencing and the effects of preventive intranasal instillation of endogenous probiotic bacteria on the lung phenotype were determined in βENaC-Tg mice and wild-type littermates. Results:Neonatal βENaC-Tg mice developed severe respiratory dysbiosis characterised by an increase in the relative abundance of Streptococcus and a decrease in Ligilactobacillus compared to wild-type littermates. Ligilactobacillus murinus SMH17 was identified as the dominant Ligilactobacillus species in the lungs of neonatal wild-type mice. Preventive treatment by intranasal instillation of L. murinus SMH17 was well tolerated and reduced age-specific markers of airway inflammation including inflammatory cell counts and proinflammatory cytokines in neonatal and juvenile βENaC-Tg mice. In addition, preventive treatment with L. murinus SMH17 reduced airway mucus plugging in βENaC-Tg mice by ∼40%. Conclusion:Preventive intrapulmonary application of the endogenous probiotic L. murinus SMH17 reduces airway inflammation and mucus plugging in mice with CF-like lung disease. These data support further elucidation of inhaled probiotics as a strategy to treat chronic airway dysbiosis in patients with CF.
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism, leading to high pulmonary arterial pressures. Pulmonary endarterectomy (PEA) surgery is the gold standard treatment for CTEPH, significantly improving patient outcomes. Post-operative cardiac remodelling is an important consideration, highlighting the need to balance early exercise with potential impacts on cardiac recovery. The objective of the present study was to investigate the safety and feasibility of early exercise interventions following PEA surgery for CTEPH, and to review the existing literature on early exercise interventions post-PEA. Methods A systematic review was conducted using the AMED, CINAHL, Embase and MEDLINE databases. Search terms included “pulmonary endarterectomy”, “chronic thromboembolic pulmonary hypertension”, “exercise”, “exercise training”, “mobility” and “rehabilitation”. Studies were included if they involved adult patients with CTEPH who underwent PEA and participated in post-operative exercise interventions. Results The review identified studies with small, heterogeneous patient cohorts engaging in early post-operative exercise following PEA. Interventions included walking, cycling, dumbbell exercises and respiratory training. Safety measures, such as continuous monitoring of oxygen levels and heart rate, were implemented and no adverse events were reported. Improvements in exercise capacity and right heart measurements were observed, suggesting that early exercise is both safe and beneficial. Conclusion Early exercise interventions following PEA surgery appear safe and feasible, with potential benefits for exercise capacity and cardiac remodelling. Future research should include randomised controlled trials and qualitative studies to confirm these findings and assess impacts on patient quality of life.
Eosinophilic pleural effusion refers to a nonspecific entity that may occur secondary to a variety of aetiologies with most common causes being malignancy and pleural injury, while a considerable proportion of cases remain with no diagnosis https://bit.ly/42FxCcm.
Background A 5-domain composite Core Outcome Measures set for Severe Asthma (COMSA) has been introduced for evaluation of treatment response. Methods The COMSA evaluation strategy was tested in a real-world study of 78 patients with severe asthma with blood eosinophilia taking mepolizumab. Exacerbations, oral corticosteroid (OCS) use, forced expiratory volume in 1 s, Asthma Quality of Life Questionnaire score and Asthma Control Questionnaire-5 results were determined before treatment and 4, 12, 24 and 36 months thereafter. Responses were quantified as the sum of changes in domains using both the relative CONFiRM (CompOsite iNdexes For Response in asthMa) scale, where exacerbations and OCS use are given most weight, and Modified Equal Weight Score (MEWS), where each domain gives equal weight. Both scales use identical cut-offs for degree of change within domains. Results After 1 year, the MEWS scoring system classified 13% as non-responders, 28% as sufficient-responders, 40% as substantial-responders and 19% as super-responders. Using CONFiRM, the corresponding group stratification was 22%, 22%, 33% and 23%, respectively. Group assignments remained unchanged at 24 and 36 months, for 66% of patients in COMSA-MEWS and 68% in COMFiRM. Baseline exhaled nitric oxide was highest among the super-responders, whereas other type 2 markers were similar across the groups. Conclusion In this first real-world application, the COMSA stratification assigned patients into distinct, graded responder groups that may be used in clinical research and management of severe asthma. Although patient-reported symptoms are given greater weight in COMSA-MEWS, the two algorithms performed similarly.
Sex hormones may be treatable traits in asthma among women. Effects of hormone replacement therapy (HRT) on asthma exacerbations are mixed and likely vary by HRT-related factors and individual susceptibility, warranting further study. https://bit.ly/4cZXVzH.
