Background: Severe asthma patients receiving biologic therapy require accurate functional assessment and longitudinal monitoring. Spirometry and impulse oscillometry (IOS) may provide complementary information on lung function. The aim of this study was to compare spirometry and IOS in severe asthma patients treated with biologics, evaluating their concordance and clinical relevance, and to assess longitudinal changes in asthma control, oral corticosteroid (OCS) use, exacerbations, and healthcare utilization over 18 months. Methods: In this real-world dual-centre longitudinal study, 40 patients with severe asthma treated with biologic therapy underwent spirometry and IOS at baseline and after 6, 12, and 18 months. Functional findings were compared between the two techniques and correlated with asthma control, OCS use, exacerbations, hospitalizations, and healthcare utilization. Results: Significant clinical improvement was observed over 18 months, with reductions in exacerbations, hospitalizations, healthcare utilization and OCS use, alongside improved ACT scores. FEF25–75% showed partial functional improvement and significant correlations with IOS indices, particularly R5–R20 (r=−0.52 to −0.65) and AX (r=−0.30 to −0.54), supporting the complementary role of oscillometry in longitudinal assessment. Conclusions: Biologic therapy significantly reduced the clinical burden of severe asthma. IOS may provide complementary information alongside spirometry for longitudinal functional monitoring in real-life setting.
BACKGROUND:If ultrasound dedicated software for the identification and quantification of interstitial syndrome is equal or superior to experts observation is still being explored. The primary objective of this study was to compare the performance of an automatic method based on a dedicated software algorithm with that of expert clinicians in terms of B-lines quantification. METHODS:Adult patients with acute respiratory failure who were deeply sedated, paralysed and mechanically ventilated were prospectively enrolled within 48 hours from ICU admission and underwent lung ultrasound by a trained physician. For each patient, 12 clips were stored, one for each thoracic region. The clips were then analyzed automatically using a built-in automatic recognition system and visually by two experts. A score of 0 was assigned if fewer than two B-lines were detected, a score of 1 if three or more B-lines were detected and a score of 2 if coalescent B-lines were detected. RESULTS:A total of 40 patients were included in the study. Out of the 480 clips analysed, 54.2% had a lung score of 0, 6.8% had a lung score of 1, 8.8% had a lung score of 2 and 20.2% had a lung score of 3. The agreement between the experts in detecting the scores 0, 1, 2 was excellent (ICC = 0.82) in 383 (79.8%) clips. The agreement between the automatic system and the experts was poor (ICC = 0.33), with a significant difference (p < 0.001). CONCLUSIONS:In mechanically ventilated patients with acute respiratory failure, an automatic B-lines quantification system did not present an acceptable accuracy compared to expert consensus for B-lines counting, probably due to the coexistence of consolidation and pleural effusion.
INTRODUCTION:In-hospital cardiac arrest is associated with poor outcomes, yet peri-procedural code status discussions before bronchoscopy may be inconsistent, particularly in patients with elevated procedural risk. METHODS:We conducted an anonymous online survey of a convenience sample of hospital-based pulmonologists in Germany and Switzerland between April and July 2025. The survey assessed routine practices and attitudes regarding peri-procedural code status discussions, risk stratification, and management of patients with pre-existing No-CPR status. Owing to distribution through multiple channels and secondary forwarding, a precise response rate could not be calculated. RESULTS:A total of 148 pulmonologists participated (mean age 47.8 years; 94.6% board-certified). Discussions regarding CPR preferences were conducted almost always or most of the time before high-risk bronchoscopies by 67.6% of respondents, but were rarely or almost never performed before low-risk procedures by 72.0%. Respondents more frequently reported procedural risk than patient-related factors as a trigger for these discussions. Peri-procedural No-CPR status was considered controversial by 44.9%, and responsibility for these discussions varied among respondents. Only 25% reported formal institutional training. CONCLUSIONS:Substantial variability exists in peri-procedural code status practices before bronchoscopy. Clearer responsibilities and structured guidance are needed to better align care with patient preferences.
Background: Inadequate endotracheal tube (ETT) cuff sealing permits microaspiration of subglottic secretions, driving ventilator-associated pneumonia and perioperative respiratory complications. Standard cylindrical and tapered cuffs remain susceptible to microchannel formation and leakage. This pilot study evaluated a novel ETT with a 90-mm self-expanding viscoelastic cuff (V-Cuff®) operating at ambient pressure compared to standard and specialty ETTs in vitro. Methods: Five ETTs of each type—standard cylindrical (Ruschelit®), specialty tapered (Shiley Evac/TaperGuard®), and V-Cuff®—were tested at 37°C in a 3D-printed tracheal model with 5 cmH₂O positive end-expiratory pressure (PEEP). Evaluations included upper and lower pressure threshold assessments (UPTA and LPTA) and simulated swallowing (80 mmHg, 2s) and coughing (125 mmHg, 3s). Continuous and categorical outcomes were analyzed using Mann-Whitney U and Fisher's Exact tests, respectively. Results: Under 5 cmH₂O PEEP, the standard ETT leaked immediately at 0 mmHg on UPTA. Both specialty and V-Cuff® ETTs tolerated supracuff pressures >90 mmHg on UPTA (p<0.001 vs. standard). On LPTA, air leak occurred at a mean of 5 ± 0.71 mmHg (standard) and 12 ± 1.22 mmHg (specialty), whereas the V-Cuff® showed no leakage at pressures >90 mmHg (p=0.008 vs. standard and specialty). During simulated swallowing and coughing, all standard and specialty ETTs leaked (5/5), while the V-Cuff® maintained complete seal integrity without leakage (0/5; p=0.008). Conclusions: In this pilot in vitro study, the V-Cuff® ETT demonstrated superior airway sealing under all static and dynamic conditions compared to standard and tapered-cuff ETTs. These preliminary findings suggest the improved seal may reduce tracheal soiling, though prospective clinical validation is required to confirm reductions in aspiration-related complications.
Background: The overlap between asthma and obesity is becoming an increasing health concern, as overweight and obesity are linked to a higher risk of developing asthma and a greater disease burden. Objective: To assess the association between obesity and hospital-related complications, as well as early readmission rates, in asthmatic patients. Methods: This prospective observational cohort study was conducted at the Department of Chest Diseases, Ain Shams University Hospitals, between January 2024 and January 2026. A total of 75 adult patients were included and classified into three BMI groups: normal weight, overweight, and obese (n = 25 each). Clinical characteristics, pulmonary function tests, and in-hospital outcomes were assessed. Results: Asthma severity increased with BMI, with severe asthma present in 96.0% of obese patients compared with 20.0% of overweight patients and none of the normal-weight patients (p < 0.001). Obese patients had lower pre-FEV₁ % predicted (47.5 ± 21.1%) than both overweight (58.5 ± 12.4%) and normal weight patients (65.2 ± 13.5%) (p = 0.003). They also had lower oxygen saturation and longer hospital stay (p < 0.001). ICU admission occurred only in obese patients (40.0%), with 20.0 % requiring mechanical ventilation. BMI correlated with longer hospital stay and lower oxygen saturation (p < 0.001). Predictors of ICU admission included obesity, severe asthma, ventilatory support, lower oxygen saturation, and reduced FEV₁. Conclusion: Higher BMI was associated with increased asthma severity, poorer control, impaired lung function, and worse clinical outcomes, including longer hospital stay and greater need for intensive care. These findings highlight the value of weight management and comprehensive care in improving outcomes for obese patients with asthma.
