Background Airway mucus plugs are associated with airflow obstruction and exacerbations in stable chronic obstructive pulmonary disease (COPD); however, their roles during exacerbations remain unclear. This study aimed to examine whether mucus plugs during exacerbations are associated with ventilatory support requirements and prognosis in patients with COPD. Methods This single-center retrospective study included patients with COPD, defined by airflow limitation on spirometry or emphysema on computed tomography (CT), who presented to the emergency department, and were diagnosed with COPD exacerbation. Mucus plugs during exacerbations were visually assessed on CT and analyzed in relation to the need for ventilatory support (primary outcome). Results Of 86 patients with a median mucus plug score of 3.5 (interquartile range, 1–7), 26 (30.2%) received ventilatory support. In multivariable logistic regression analysis, a higher mucus plug score (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.16–1.59) and higher C-reactive protein level were significantly associated with the need for ventilatory support. In a Cox proportional hazards model, a higher mucus plug score (hazard ratio [HR], 1.17; 95% CI, 1.07–1.29) and long-term oxygen therapy use were significantly associated with a shorter time to re-exacerbation or all-cause death within 1 year. Mucus plugs significantly decreased from the exacerbation to the recovery phases in a sub-analysis of 20 patients who underwent CT in both phases. Conclusion A higher mucus plug score was associated with the need for ventilatory support and poorer clinical outcomes, suggesting that mucus plugs may impair ventilation and worsen the prognosis of COPD exacerbations.
Background Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a rare type of idiopathic interstitial pneumonia characterized by upper-lobe-predominant pleural and subpleural fibrosis. Dynamic chest radiography (DCR) enables real-time assessment of respiratory motion using quantitative parameters such as diaphragm excursion, projected lung area, and low-motion area (LMA). However, its clinical utility in iPPFE remains unclear. We evaluated whether DCR-derived parameters, particularly the LMA ratio, reflect respiratory mechanical abnormalities in iPPFE. Methods In total, 302 patients who underwent DCR were retrospectively analyzed. After excluding patients with chronic obstructive pulmonary disease, combined pulmonary fibrosis and emphysema, or preoperative thoracic malignancy, 107 patients were classified into the iPPFE, idiopathic pulmonary fibrosis, other interstitial lung diseases (ILDs), and control groups. The clinical characteristics, pulmonary function, and DCR parameters of the four groups were compared. Logistic regression analysis was performed to identify factors associated with iPPFE. Results The iPPFE group had a significantly lower diaphragm excursion and change in projected lung area, and a significantly higher LMA and LMA ratio than the other groups. A low body mass index (BMI) and a high LMA ratio were independent factors associated with iPPFE. The difference in the LMA ratio remained significant after propensity score matching for age, sex, BMI, and %FVC between patients with iPPFE and those with non-iPPFE ILDs. Conclusions The LMA ratio is independently associated with iPPFE and may serve as an exploratory biomarker of impaired respiratory mechanics in iPPFE.
T-cell-engaging bispecific antibodies (BsAbs) have rapidly expanded treatment options for relapsed or refractory multiple myeloma, B-cell lymphomas, and small-cell lung cancer. Their off-the-shelf availability, step-up dosing, repeated administration, and migration into outpatient and community settings distinguish them from autologous chimeric antigen receptor (CAR) T-cell therapy. These same features increasingly bring patients to pulmonary and critical care teams. Patients receiving BsAbs may present with fever, hypoxemia, pulmonary infiltrates, pneumonia, cytokine release syndrome (CRS), secondary antibody deficiency, Pneumocystis jirovecii pneumonia (PJP), cytomegalovirus (CMV) infection, respiratory viral disease, pulmonary edema, pulmonary embolism, malignant pulmonary involvement, or suspected drug-induced lung injury. Existing guidelines provide essential CRS grading, rechallenge, and infection-prevention recommendations but do not fully address the bedside pulmonary differential diagnosis, indications for bronchoscopy, ventilatory escalation, or intensive care unit (ICU) triage. This focused narrative review synthesizes pivotal trials, current prescribing information, consensus statements, real-world studies, and pulmonary literature. We emphasize two overlapping risk windows: early step-up dosing, in which CRS and infection must be evaluated and treated in parallel, and later or prolonged therapy, in which infection, target-specific immune deficits, and noninfectious mimics become dominant considerations. A timed approach using oxygen trajectory, computed tomography pattern, host immune deficits, microbiologic data, and selective bronchoscopy may reduce diagnostic anchoring and improve multidisciplinary care.
Background De novo malignancies are a major cause of late death following lung transplantation (LTx). Although previous reports from Japan have identified post-transplant lymphoproliferative disorder (PTLD) as the most common de novo malignancy, comprehensive long-term data on the spectrum, treatment, and outcomes of de novo malignancies remain limited. Methods We retrospectively reviewed the medical records of 413 patients who underwent LTx at our institution between April 2002 and December 2025 and analyzed the incidence, characteristics, and outcomes of de novo malignancies. Results De novo malignancy was diagnosed in 53 patients (12.8%), comprising 18 cases of PTLD and 37 cases of solid tumors (42 tumors in total). The cumulative incidence of PTLD was 3.1% at 1 year and remained stable thereafter, whereas the incidence of solid tumors increased steadily over time, reaching 16.8% at 10 years after LTx. PTLD and solid tumors showed distinct temporal patterns, with median times to onset of 8.0 months and 64.0 months, respectively. Regarding post-LTx lung cancer, five of the six cases (83.3%) originated in the native lung after single LTx. The 2-year overall survival after malignancy diagnosis was significantly higher in the curative treatment group than in the non-curative group (87.9% vs. 16.7%, p < 0.001). Conclusions Our findings demonstrate that the risk of solid malignancies continues to increase during long-term follow-up after LTx. The favorable outcomes observed among patients receiving curative treatment are considered to reflect earlier detection and better baseline patients’ condition, underscoring the importance of post-transplant cancer surveillance.
