Introduction: Bronchial thermoplasty (BT) reduces airway smooth muscle and may benefit severe asthma, but its role alongside biologics remains unclear. We assessed randomised and real-world evidence on efficacy and safety. Methods: We searched PubMed, Scopus, and Cochrane Library for RCTs and observational studies of BT in adults with severe uncontrolled asthma, analysing them separately. Results: Twenty studies were included (five RCTs, 15 observational). In RCTs, BT improved asthma-related quality of life (AQLQ;MD, 0.69; 95% CI 0.30–1.09), asthma control (ACQ; MD,−0.64; 95%CI, −1.10 to −0.19), and morning peak expiratory flow (MD, 20.62 L/min; 95% CI, 4.92–36.32), but did not improve rescue medication use or symptom-free-days. BT increased the risk of hospitalisation during the treatment period (RR, 3.50; 95%CI, 1.26–9.68), with no significant excess thereafter. Real-world studies showed improvements in AQLQ (MD,1.38; 95%CI, 0.97–1.80), ACQ (MD,−1.24; 95%CI, −1.86 to −0.62), and annualised exacerbation rates (MD, −3.79 exacerbations/patient-year; 95%CI, −6.98 to −0.61). Evidence suggested a possible, inconsistent corticosteroid-sparing effect; data on biologics and long-term safety were limited. Conclusions: BT improved asthma-related quality of life and control, mainly in trials without sham controls, but increased short-term hospitalisation risk. Real-world findings were similar but came from uncontrolled studies. BT is not an established alternative to biologics, but may suit carefully selected patients with severe asthma who cannot use or do not respond to them.
Background/Objectives: We examined whether respiratory performance differed among broad stroke lesion-location categories. Methods: This exploratory single-center cross-sectional analysis combined pre-intervention assessments from 20 participants in an earlier trial with 60 subsequently recruited participants. The 80 patients were classified into frontal lobe (n = 27), basal ganglia region (n = 26), or brainstem (n = 27) categories. Peak inspiratory flow (PIF), strength index (S-Index), and five conventional respiratory outcomes were assessed. Holm correction was applied across seven outcomes. Linear models used type 3 heteroscedasticity-consistent (HC3) robust standard errors and the original six clinical covariates. Additional PIF analyses incorporated time since stroke, National Institutes of Health Stroke Scale (NIHSS), or modified Barthel Index (MBI), and restricted the sample to ischemic or first-ever stroke. Results: Only PIF retained an unadjusted group association after Holm correction (adjusted p = 0.008). The adjusted overall lesion-location association also survived correction (adjusted p = 0.009). PIF was 0.625 L/s higher in the basal ganglia region than in the brainstem group (95% confidence interval [CI], 0.282–0.967). This contrast persisted with additional clinical adjustment in the full cohort and in ischemic stroke. Evidence weakened in first-ever stroke; with MBI adjustment, the contrast was 0.381 L/s (95% CI, −0.067–0.829). Conclusions: Broad lesion-location categories were associated with PIF in this selected cohort. The findings remain exploratory and cannot fully separate anatomical associations from stroke severity, disability, unmeasured clinical factors, or measurement limitations.
Patients with advanced chronic obstructive pulmonary disease (COPD) respond differently to pulmonary rehabilitation (PR), and respiratory impairment alone might not fully explain this variability. Behavioral adaptation may contribute to differences in rehabilitation response. We studied 102 patients with advanced COPD (GOLD III–IV) who completed a 3-week multidisciplinary PR program. Functional response was assessed by change in six-minute walking distance (6MWD). Clinical, functional, psychological, lifestyle, and immune characteristics were evaluated, including coping strategies measured with the Brief COPE, Torque Teno virus (TTV) viremia, and circulating T-cell subsets. Exploratory mediation analyses examined whether coping strategies contributed to the association between age and rehabilitation response. Greater improvement in 6MWD was associated with higher active coping and planning scores, while self-distraction also differed across response groups. Planning scores were higher in good responders than in non-responders (7.10 ± 1.35 vs. 5.05 ± 1.93, respectively; p < 0.001). Planning was the only coping strategy showing a statistically significant indirect effect in the exploratory mediation analysis. The estimated proportion mediated was approximately 26.5%, although the wide confidence interval indicated substantial uncertainty. These findings should be interpreted cautiously given the observational design and the assessment of multiple coping strategies. Conventional physiological measures, lifestyle characteristics, and immune biomarkers—including TTV viremia and circulating T-cell subsets—did not significantly distinguish rehabilitation response groups. Planning and active coping were associated with response in both sexes. A separate pilot randomized study, IMPROVE (n = 36), was subsequently conducted to investigate whether structured psychological support could influence coping strategies and help maintain the benefits of PR. At six months, patients receiving psychological support showed better maintenance of rehabilitation benefits, alongside improvements in psychological well-being, quality of life, and selected coping strategies. These findings provide preliminary evidence that coping-related characteristics may be modifiable; however, IMPROVE was a separate exploratory intervention study and was not designed to validate the observational findings. Assessment of coping strategies may complement clinical and functional evaluation and help identify patients who could benefit from tailored psychological support. Their clinical utility and the effectiveness of targeted interventions require confirmation in larger prospective studies.
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic interstitial lung disease with high morbidity and mortality. Inhaled treprostinil showed pulmonary vascular and lung-function signals in pulmonary hypertension associated with Interstitial lung disease (PH-ILD) and was subsequently tested in IPF trials. Objectives: This systematic review and meta-analysis assessed the efficacy and safety of inhaled treprostinil in adults with IPF. Methods: PubMed, Google Scholar and the Cochrane Library/CENTRAL were searched for records published from January 2000 to 2026. A random-effects meta-analysis used the DerSimonian–Laird tau squared and inverse-variance weighting methods. Continuous outcomes were pooled as generic inverse-variance effects from reported estimates and 95% confidence intervals. Hazard ratios were pooled on the log scale. Safety outcomes were pooled as risk ratios from event counts. Results: The searches identified 1552 records. After deduplication, 379 records were screened and 85 full-text reports were assessed. Eleven reports were included in the systematic review. TETON-1 and TETON-2 were the two direct-IPF randomized trials within the coordinated TETON program eligible for primary meta-analysis. Inhaled treprostinil improved absolute forced vital capacity (FVC) change at 52 weeks compared with placebo (MD 111.28 mL, 95% CI 77.61 to 144.95, p < 0.001; I squared 8.5%). Clinical worsening was reduced (HR 0.69, 95% CI 0.57 to 0.84, p < 0.001; I squared 0.0%). Acute exacerbation was lower in pooled analysis (HR 0.52, 95% CI 0.30 to 0.91, p = 0.022), while all-cause mortality did not differ significantly (HR 0.70, 95% CI 0.47 to 1.05, p = 0.086). Adverse-event discontinuation, cough and headache were more frequent with treprostinil. Conclusions: In direct IPF randomized evidence, inhaled treprostinil preserved lung function and reduced clinical worsening at 52 weeks.
Population-based lung cancer screening with low-dose computed tomography (LDCT) is expanding across Europe, including a publicly funded Polish programme starting in October 2026. Because screening-eligible individuals share substantial tobacco-related cardiovascular risk, LDCT also offers cardiovascular risk assessment without additional radiation. We conducted a narrative review of the PubMed literature published up to September 2026, prioritising guidelines, lung cancer screening cohorts and systematic reviews. We summarise the cardiovascular findings on non-contrast, non-electrocardiography (ECG)-gated LDCT: coronary artery, aortic valve, mitral annular and thoracic aortic calcification, ascending aortic dilatation, pericardial effusion, and pulmonary artery enlargement, as well as investigational cardiac volumetry, epicardial adipose tissue and artificial intelligence (AI)-assisted quantification. We grade each finding by reportability, defined downstream action and supporting evidence, and align reporting thresholds with the European Respiratory Society/European Society of Thoracic Imaging (ERS/ESTI) statement on incidental findings. LDCT cannot replace dedicated cardiac imaging or establish haemodynamic diagnoses. The prognostic value of coronary and aortic valve calcification and of ascending aortic dilatation is established, whereas the evidence for mitral annular calcification and pulmonary artery enlargement is more limited; observational data indicate that reporting these markers changes preventive management, but whether this improves cardiovascular outcomes has not yet been demonstrated. Standardised reporting, proportionate thresholds, and coordinated pathways linking radiology, pulmonology, primary care and cardiology are needed to translate incidental cardiovascular findings into scalable prevention and should be evaluated in implementation studies.
