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.
