Background People with HIV (PWH) may experience accelerated aging, chronic inflammation, early immunosenescence, and increased vulnerability to pneumonia. However, data on pneumonia outcomes in older PWH compared with people without HIV remain limited. Methods We conducted a retrospective analysis of prospectively collected data from November 1996 to March 2025, including adults hospitalized with community-acquired pneumonia (CAP). The primary endpoint was 30-day mortality; secondary outcomes included in-hospital and 1-year mortality, intensive care unit (ICU) admission, hospital and ICU length of stay, ICU mortality, and mechanical ventilation. Propensity score matching (PSM) was used to balance baseline characteristics between groups. Results Among 5404 patients with CAP, 5306 (98%) were HIV negative and 98 (2%) were PWH. In the unmatched cohort, PWH were younger, more likely to be smokers, and more likely to report alcohol misuse; they also had more comorbidities and prior pneumonia. Despite milder initial clinical features and lower inflammatory marker levels, PWH had longer ICU stays. HIV status was not associated with ICU admission or 30-day or 1-year mortality in crude analyses. After PSM (96 PWH vs 96 HIV-negative patients), baseline differences were minimized, and no significant differences in outcomes were observed: ICU admission, 21% vs 25% (OR, 0.78; 95%CI, 0.40–1.55); 30-day mortality, 8% vs 3% (HR, 2.76; 95%CI, 0.73–10.39); and 1-year mortality, 12% vs 7% (HR, 2.60; 95%CI, 0.82–8.29). Conclusions In this single-center cohort of adults aged ≥50 years hospitalized with CAP, we did not demonstrate a statistically significant association between HIV infection and mortality after propensity score matching. However, the limited sample size and wide confidence intervals reduce statistical precision, and clinically relevant differences cannot be excluded.
BACKGROUND:Idiopathic pulmonary fibrosis (IPF) predominantly affects older adults. Frailty is increasingly recognized as an important feature of IPF, although its prognostic value remains uncertain. This study aimed to assess the prevalence of frailty and concordance among validated instruments, characterize the principal domains of vulnerability identified through comprehensive geriatric assessment (CGA), and evaluate the prognostic value of integrating frailty with indices of respiratory disease severity in older adults with IPF. METHODS:We conducted a prospective, single-center study of patients aged 65 years or older with confirmed IPF. Frailty was assessed using the Fried frailty phenotype (FFP), a CGA-derived Frailty Index (CGA-FI), and the Clinical Frailty Scale (CFS). The primary outcome was a composite of all-cause mortality or acute exacerbation during follow-up. Cox proportional hazards models and bootstrap-derived concordance indices were used to evaluate prognostic associations and model discrimination. RESULTS:Among the 140 patients included, the prevalence of frailty ranged from 16.4% according to the CGA-FI to 22.3% according to the FFP, whereas 19.3% were classified as frail according to the CFS. During a median follow-up of 465 days (IQR, 221-1076 days), 35 patients (25.0%) experienced the composite outcome. Frailty assessed using the CFS (CFS ≥5: HR, 3.94; 95%CI, 1.81-8.58) and a higher Gender-Age-Physiology (GAP) stage (GAP II-III: HR, 3.11; 95%CI, 1.39-7.00) were independently associated with the composite outcome. The integrated GAP-CFS model showed good discrimination, with a bootstrap-derived Harrell C index of 0.72 (95%CI, 0.62-0.81). Patients who experienced events also had higher Strength, Assistance in Walking, Rising From a Chair, Climbing Stairs, and Falls (SARC-F) scores and greater functional impairment. CONCLUSIONS:Frailty is common and clinically relevant in IPF. Integrating frailty measures with pulmonary indices improves prognostic stratification and supports the use of the CFS and CGA to guide personalized, multidimensional care.
OBJECTIVE:To characterise long-term mask-type trajectories among patients receiving continuous positive airway pressure (CPAP) and assess their associations with CPAP nonadherence and treatment termination. METHODS:This real-world longitudinal cohort study included newly diagnosed adults treated with CPAP for more than 1 month. Patients had unrestricted access to 48 models across 4 mask types: nasal masks (NMs), oronasal masks (ONMs), and nasal-pillow masks (NPMs), with the latter subdivided into nasal-cradle masks (NCMs) and intranasal masks (INMs). Sequence analysis was used to identify mask trajectories, and multivariable models were used to estimate odds ratios (ORs) for CPAP nonadherence and treatment termination. RESULTS:Among 4675 patients, the median duration of CPAP treatment was 1.5 years (IQR, 0.7-2.8 years); 21.8% were nonadherent, and 26.1% terminated treatment. Adherent patients changed mask type less frequently than nonadherent patients and those who terminated treatment (43.7% vs 50.4% and 53.8%, respectively; p<.001). NM use decreased from 72.3% to 43.1%, whereas ONM use increased from 19.8% to 37.0%, INM use from 2.4% to 6.5%, and NCM use from 5.5% to 13.4%. Fifteen trajectories were identified. Compared with NM renewal, ONM and INM renewal were not associated with a higher risk of nonadherence or treatment termination, whereas NCM renewal was associated with CPAP termination (OR, 1.60; 95%CI, 1.04-2.47; p=.034). Switching from an initial NM to an INM (OR, 1.68; 95%CI, 1.18-2.39; p=.004), NCM (OR, 1.76; 95%CI, 1.26-2.45; p=.001), or ONM (OR, 1.31; 95%CI, 1.01-1.70; p=.046) was associated with CPAP termination. CONCLUSIONS:In routine clinical practice, NM, ONM, and INM renewal trajectories were comparable, whereas NCM renewal was associated with unfavourable outcomes. Switching from an NM to an ONM or NPM was associated with poorer CPAP use. NCMs and INMs should not be pooled under the general NPM category. TRIAL REGISTRATION:The SwitchAdene study is registered with the Health Data Hub under registration No. 19334378.
OBJECTIVES:This study evaluated the performance of seven POCs, focusing on FiO2, bolus triggering delay, synchronization, and technical specifications, including weight, size, noise level, and battery autonomy. METHODS:A bench study was conducted using a mechanical lung model (ASL 5000) equipped with a Fast Oxygen Measurement sensor. Seven devices available on the European market were tested: FreeStyle Comfort, iGo2, Inogen One G4, Inogen One G5, Platinum Mobile, Zen-O lite, and Horizon P5. 200 ventilatory cycles were simulated per device across various respiratory rates (RR). Measurements included FiO2, bolus triggering delay, synchronization, and bolus volume. Technical specifications were also compared. All devices were tested across their full range of settings, with each test replicated on a second device to confirm results within a 10% margin of error. RESULTS:Significant differences in FiO2 delivery were observed (p<0.001), with all devices delivering at least 28% FiO2 at their lowest settings. The Inogen One G5 and Horizon P5 achieved the highest FiO2 levels (48.7% [38.4-56.9%] and 47.8% [35.6-56.4%], respectively). Synchronization was high across devices but declined at extreme RR (15 and 40bpm). FiO2 variations were influenced by RR, while bolus delays depended on device type and RR. Technical specifications varied widely across devices. CONCLUSIONS:POCs demonstrate notable differences in performance, with RR and device type impacting FiO2 delivery and synchronization. These findings may help support more informed device selection according to the intended conditions of use and patient requirements.
OBJECTIVES:This study aimed to identify major contributors to poor adherence to inhaled therapy in a large cohort of patients with severe chronic obstructive pulmonary disease (COPD). METHODS:This was a post hoc analysis of 4801 patients with severe COPD included in an observational, cross-sectional, multicenter study (the CLAVE Study) in which clinical control criteria were used to evaluate the control of COPD in Spain. All patients had a post-bronchodilator forced expiratory volume in 1 second (FEV1)<50% predicted and received inhaled medication. The test of adherence to inhalers (TAI) was used to assess the types of non-adherence. RESULTS:The TAI questionnaire was completed by 4537 patients, with an overall rate of non-adherence of 39.0% (n=1770). The degree of adherence was intermediate in 887 (19.6%) and poor or non-adherent in 883 (19.5%). The rates of non-adherent behaviors were 37.1% for erratic, 25.0% for deliberate and 13.6% for unconscious (unwitting). Current smoking and patient's care in the primary care setting showed the highest odds ratio in the regression analysis. Poorly controlled disease, symptomatic COPD, and exacerbator and eosinophilic phenotypes were significantly associated with poor adherence. CONCLUSIONS:Non-adherence to inhaled therapy was found in 39% of patients with severe COPD attended in real-life conditions. Notably, unconscious type of non-adherence found in 13.6% of the overall study population increasing to 31% in patients with poor adherence highlights the need of consistently ensuring that patients understand their therapeutic regimen and use devices correctly over the entire follow-up of COPD.
BACKGROUND:Mortality due to idiopathic pulmonary fibrosis (IPF) has been reported to be increasing in Spain, although the temporal evolution and regional differences across autonomous communities have not been fully characterized. OBJECTIVE:To analyze national and regional age-adjusted IPF mortality trends in Spain from 1999 to 2021 and to identify changes in temporal patterns using Joinpoint regression. METHODS:Age-adjusted mortality rates per 100,000 inhabitants were obtained from the Statistical Portal of the Spanish Ministry of Health for men and women in Spain and its autonomous communities. Deaths coded under ICD-10 J84.112 were included. Joinpoint regression was performed to estimate Annual Percent Change (APC) and detect inflection points in mortality trends. Statistical significance was set at p<0.05. RESULTS:National IPF mortality increased from 2.17/100,000 in 1999 to 2.85/100,000 in 2021. Two distinct phases were identified: an increase from 1999-2016 (APC 2.42%; 95% CI 1.8-3.0) followed by a decline from 2016-2021 (APC -2.83%; 95% CI -9.0 to 1.6). Men showed an increasing trend until 2016 (APC 2.40%), followed by an observed downward trend from 2016 to 2021 (APC -3.71%), although the confidence interval was wide and did not clearly exclude no change, while women exhibited a similar pattern (APC 1.45% to -3.97%) but with a more consistent decline after 2016. Regional trends varied substantially, with several communities displaying non-parallel trajectories compared with the national trend; only Baleares, Murcia and La Rioja experienced overall declines during the study period. CONCLUSIONS:IPF mortality in Spain increased over the 22-year period but showed a likely downward trend that needs a prospective confirmation and marked regional heterogeneity. These findings underscore the need for continued monitoring and regional evaluation of IPF-related healthcare practices.
BACKGROUND:Extreme temperatures pose a substantial respiratory health threat, yet their impact on severe clinical outcomes in temperate settings remains unclear. We examined associations between heat and cold exposure and respiratory mortality and hospitalizations in Copenhagen, Denmark. METHODS:We conducted a time-stratified case-crossover study among adults aged≥30 years from 2002 to 2018. Daily temperature was related to mortality, hospitalizations, and fatal hospitalizations for all respiratory diseases, acute lower respiratory infection (ALRI), and chronic obstructive pulmonary disease (COPD). Conditional logistic regression estimated relative risks (RRs) with 95% confidence intervals (CIs) across lags up to 21 days. Stratified analyses evaluated susceptibility by sex, age, and income. RESULTS:We identified 162,665 respiratory hospitalizations, 23,600 fatal respiratory hospitalizations, and 16,610 respiratory deaths. Extreme heat (99th percentile, lag 0-7 days) was associated with respiratory hospitalizations (RR=1.07; 95% CI: 1.01, 1.14), with stronger associations for fatal respiratory hospitalizations (RR=1.25; 95% CI: 1.08, 1.43) and fatal ALRI (RR=1.34; 95% CI: 1.09, 1.65). Heat effects on mortality exceeded those on hospitalizations for all respiratory diseases (RR=1.35; 95% CI: 1.14, 1.59) and COPD (RR=1.48; 95% CI: 1.17, 1.86). Risks were most pronounced among males and adults ≥75 years. Prolonged cold increased respiratory hospitalizations but showed a non-significant association with fatal hospitalizations. CONCLUSION:Extreme heat and prolonged cold both increased respiratory morbidity, while extreme heat additionally elevated the risk of fatal respiratory hospitalization and mortality, particularly among males and older adults, suggesting a substantial preventable burden.
