Urinary incontinence (UI) is common among female patients with chronic cough; however, factors associated with persistent UI and related clinical outcomes remain insufficiently defined. Longitudinal data were analyzed from female patients with chronic cough enrolled in the Korean Chronic Cough Registry. Study participants received cough guideline-based management. Cough-associated UI status and patient-reported outcome (PRO) measures were evaluated at baseline and at 6 months. UI status was categorized as persistent, resolved, or absent based on findings at both time points. Baseline clinical characteristics were compared across groups, and regression analyses were conducted to identify factors associated with persistent UI and to estimate longitudinal changes in PROs. Among 206 female study participants, 24.3

The cough severity visual analogue scale (VAS) and the Leicester Cough Questionnaire (LCQ) are commonly used in chronic cough. While continuous scores are useful for tracking change, categorization is needed to define clinically relevant states. However, patient-anchored thresholds for cough control remain undefined. Using the Korean Chronic Cough Registry (n = 890), we derived VAS and LCQ cutoffs anchored to a patient-reported cough control item. Receiver operating characteristic (ROC) analyses were performed using operational definitions of very well-controlled cough (“strongly agree” vs. all others), well-controlled cough (“strongly agree” + “agree” vs. all others), and uncontrolled cough (“disagree” + “strongly disagree” vs. all others). Both scores demonstrated stepwise gradients across cough control categories (p < 0.001). ROC-derived cutoffs for very well-controlled cough were VAS ≤ 10 (area under the curve [AUC], 0.911) and LCQ ≥ 15.8 (AUC, 0.877). For well-controlled cough, the corresponding cutoffs were VAS ≤ 30 (AUC, 0.866) and LCQ ≥ 15 (AUC, 0.856). For uncontrolled cough, the cutoffs were VAS ≥ 50 (AUC, 0.879) and LCQ ≤ 13.0 (AUC, 0.872). Cutoffs were consistent across newly referred chronic cough and refractory chronic cough subgroups. Concordance between VAS- and LCQ-derived classifications was moderate-to-substantial (weighted kappa = 0.55). Based on these findings, we propose a patient-anchored classification framework for cough control: very well-controlled cough (VAS ≤ 10, LCQ ≥ 16), well-controlled cough (VAS 11–30, LCQ 15.0–15.9), intermediate cough control (VAS 31–49, LCQ 13.1–14.9), and uncontrolled cough (VAS ≥ 50, LCQ ≤ 13). These thresholds warrant validation in diverse populations.

BACKGROUND:Fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is a single-inhaler triple therapy administered via the ELLIPTA inhaler. FF/UMEC/VI 100/62.5/25µg was approved in Korea to treat COPD in 2018 and asthma in 2022 (100/62.5/25µg and 200/62.5/25µg). Safety and efficacy of FF/UMEC/VI are well established in global clinical trials, though Korean real-world evidence remains limited. METHODS:This Korean multicentre post-marketing surveillance assessed safety and clinical outcomes of FF/UMEC/VI 100/62.5/25µg in COPD (May 2018-May 2024) and safety of FF/UMEC/VI in asthma (100/62.5/25µg: August 2022-May 2024; 200/62.5/25µg: September 2022-May 2024). Safety was assessed by total, serious and unexpected adverse event (AE) and adverse drug reaction (ADR) incidence. For COPD, physicians assessed within-patient improvement in clinical outcomes (lung function [FEV1, FVC], exacerbations and symptoms [mMRC dyspnoea, CAT]). RESULTS:Overall, 606 patients with COPD and 132 patients with asthma were evaluated. Mean (SD) administration for FF/UMEC/VI 100/62.5/25µg was 254.11(119.97) days overall; 271.83(104.99) for COPD; 20.74(10.87) for integrated asthma; 34.17(13.06) days for asthma with FF/UMEC/VI 200/62.5/25µg. ADRs occurred in 2.64% (16/606) of patients with COPD and 3.79% (5/132) with asthma. Most ADRs were mild; all serious/unexpected ADRs resolved. Of 33 patients with COPD who reported pneumonia, all events were considered unlikely to be treatment-related. Physicians determined improvement in 74.87% (283/378) of patients with COPD post- versus pre-FF/UMEC/VI administration. Conclusions:FF/UMEC/VI was well tolerated in Korean patients with asthma or COPD, with no new safety concerns identified. In COPD, within-patient improvement was observed in clinical outcomes post-administration. These results support continued FF/UMEC/VI use in real-world clinical practice in Korea.

Although immune checkpoint inhibitors (ICIs) have led to a fundamental shift in lung cancer treatment, evidence regarding infections remains limited. Pneumocystis jirovecii pneumonia (PJP) is a rare but life-threatening opportunistic infection with high mortality if undiagnosed or untreated, making its risk assessment clinically critical. This study aimed to provide population-based comparative evidence on the risk of PJP between ICI therapy and conventional cytotoxic chemotherapy (CC) in patients with lung cancer. Using the Korean nationwide claims data, we conducted a retrospective cohort study of patients newly diagnosed with lung cancer who initiated CC or ICI therapy between 2017 and 2022. After propensity score matching, incidence rate ratios (IRRs), Cox hazard ratios (HRs), and Fine-Gray subdistribution HRs (sHRs) were estimated. Sensitivity analyses were performed across clinically relevant subgroups, including those defined by advanced stage, surgical resection, radiotherapy, treatment line, ICI monotherapy, and systemic corticosteroid use. Additionally, risk patterns across specific ICI agents, including atezolizumab, pembrolizumab, durvalumab, and nivolumab, were evaluated in an exploratory analysis. After matching, 13,426 patients were included in each group. During follow-up, 27 and 66 PJP events occurred in the CC and ICI groups, respectively, corresponding to IRs of 3.35 and 7.77 per 1,000 person-years. ICI therapy was associated with a significantly higher risk of PJP (adjusted IRR 2.26, 95

Background:Severe asthma is associated with poor asthma control, leading to poor outcomes. However, few studies have evaluated asthma control status in patients with severe asthma in the biologic era. This study aimed to evaluate baseline asthma control in patients with severe asthma using phase 2 of the Korean Severe Asthma Registry (KoSAR-2). Methods:Adult subjects meeting the international consensus definition of severe asthma were prospectively enrolled from 41 hospitals in Korea (March 2022 to June 2023). Data on demographics, comorbidities, lung function, inflammation and healthcare utilisation were collected. Using asthma control test (ACT) scores, patients were classified into a well-controlled asthma group (ACT ≥20) and poorly controlled asthma group (ACT <20). Results:Among 594 severe asthma patients, 51.9% had poorly controlled asthma. Multivariable analysis showed that medical aid (adjusted odds ratio (aOR)=5.515, 95% confidence interval (CI) 2.614-13.110, p<0.001), being underweight (aOR=4.129, 95% CI 1.081-20.192), forced expiratory volume in 1 s <60% predicted (aOR=1.854, 95% CI 1.090-3.175) and prior exacerbations (aOR=3.400, 95% CI 1.987-6.012) were associated with poorly controlled asthma, while T2 inflammation was associated with well-controlled asthma (aOR=0.560, 95% CI 0.316-0.977). However, biologic use was not associated with asthma control status. Conclusions:About half of patients with severe asthma in KoSAR-2 had poorly controlled asthma at baseline. While poor socioeconomic status reflected by medical aid was a key factor underlying poor asthma control, T2 inflammation was associated with better asthma control in severe asthma. These findings underscore the importance of both clinical management and socioeconomic support to improve asthma control outcomes.

The coronavirus disease 2019 (COVID-19) vaccination is suggested to be effective in improving outcomes of chronic obstructive pulmonary disease (COPD). However, real-world evidence on long-term mortality among individuals with COPD, accounting for both vaccination and COVID-19 infection status, remains sparse. A retrospective cohort study was conducted using datasets from the Korean National Health Insurance system. Through two-step propensity score matching, 716 individuals with COPD were included in the analysis and classified into four groups according to COVID-19 vaccination and severe acute respiratory syndrome coronavirus 2 infection status: 125 COVID-19 vaccinated/uninfected, 125 vaccinated/infected, 233 unvaccinated/uninfected, and 233 unvaccinated/infected. A multivariable Cox proportional hazards regression analysis was conducted to assess the risk of mortality following COVID-19 vaccination and SARS-CoV-2 infection status. The median follow-up period was 420 days, during which 79.6

BACKGROUND:While chronic airway inflammation and remodeling are well-established features of severe asthma, the associated vascular changes remain poorly understood. OBJECTIVE:We assessed severity-related changes in pulmonary vascular remodeling and their associations with clinical features and computed tomography (CT)-based airway functional measures among patients with asthma. METHODS:Full inspiratory and normal expiratory CT scans were analyzed from 159 healthy subjects, 53 patients with nonsevere asthma, and 159 patients with severe asthma after 3:1:3 propensity score matching. Total pulmonary blood vessel volume during inspiration and expiration (respectively, TBVIN and TBVEX), vascular compressibility between inspiration and expiration (TBVcomp), and expiratory small-vessel fraction were quantified. Associations with clinical variables and CT-derived indexes-air-trapping percentage (AirT%) and parenchymal deformation (Jacobian)-were assessed by multivariable regression. RESULTS:TBVcomp decreased stepwise from healthy subjects to those with nonsevere and severe asthma (P < .05). In multivariable regression analyses with additional adjustment for Jacobian and AirT%, higher TBVEX was significantly associated with worse lung function (lower percentage predicted forced expiratory volume in 1 second [FEV1], β = -0.40; lower FEV1/FVC, β = -0.26) and higher cumulative steroid corticosteroid dose (β = 0.13, all P < .05). Lower TBVcomp remained independently associated with higher blood eosinophil count (β = -0.37, P < .05). CONCLUSION:TBVcomp decreases with increasing asthma severity and remains independently associated with type 2 inflammation and possibly with clinical burden after accounting for lung mechanics. These findings suggest that CT-based expiratory vascular metrics capture intrinsic vascular alterations beyond mechanical factors and may add value for asthma phenotyping and disease monitoring.

Summary • During a one‐year follow‐up, approximately 20% of patients with aetiology‐explained chronic cough transitioned to refractory cough. • Cough hypersensitivity showed an age‐dependent association with transition to refractory chronic cough.

Summary Box Adult TB survivors have a 26% higher risk of incident asthma than matched controls. Older age, female sex, obesity, heavy smoking and COPD are key risk factors.

Purpose: The impact of socioeconomic status on asthma control has been widely investigated. However, evidence regarding the impact of health insurance type on biologic utilization and systemic corticosteroid (SCS) exposure among patients with severe asthma remains limited. This study aimed to evaluate the associations between health insurance type, biologic utilization, and SCS dose in South Korea. Methods: Data from the Korean Severe Asthma Registry (KoSAR) between March 2022 and October 2023 were analyzed. Patients were categorized into 4 different groups based on their health insurance type: National Health Insurance (NHI) with private health insurance (PHI), NHI-only, and Medical Aid (MA) with PHI, and MA-only. Results: Among the 578 patients with severe asthma, 327 (56.6%) were classified as NHI+PHI, 192 (33.2%) as NHI-only, 22 (3.8%) as MA+PHI, and 37 (6.4%) as MA-only. Decline in lung function, asthma exacerbations, and impaired quality of life were significantly more prevalent in the MA+PHI and MA-only groups. Overall, 159 patients (27.5%) were identified as biologic users. The most frequently prescribed biologics were dupilumab (8.8%), reslizumab (8.5%), omalizumab (7.1%), followed by mepolizumab (2.3%). Biologic utilization varied significantly by insurance type, with rates of 30.9% in the NHI+PHI group, 27.1% in the NHI-only group, and only 8.1% in the MA-only group (P = 0.011). Conversely, dependence on SCS (defined as SCS use for more than one month) showed an inverse pattern, being most prevalent in the MA-only group (52.6%), followed by the NHI-only group (36.8%) and the NHI+PHI group (26.7%) (P = 0.017). Conclusions: Our study showed that differences in biologic and SCS use were associated with insurance type. These findings suggest that insurance coverage and out-of-pocket expenses are important factors influencing access to optimal care for severe asthma, emphasizing the need for policy interventions to promote health equity.

PURPOSE:Specialist cough clinics operate in various countries to address the complex needs of patients with chronic cough. Despite their increasing recognition and the recent establishment of an international consensus, such as the European Respiratory Society NEUROCOUGH initiative, no formal agreement on the goals and standards of chronic cough clinics has been established in South Korea. To address this gap, the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and its Chronic Cough Working Group initiated a Delphi study to develop an expert consensus on the objectives, roles, and standards of chronic cough clinics tailored to the Korean healthcare context. METHODS:A Task Force endorsed by KAAACI and composed of members of the Chronic Cough Working Group conducted a 2-round Delphi survey involving 113 clinicians with relevant clinical or research expertise. The panel evaluated 12 statements and 17 diagnostic items. A consensus was defined as > 70% agreement and < 20% disagreement. RESULTS:Consensus was achieved for all 12 statements (agreement rates, 93.9%-99%), covering clinical care, research, and education. The key agreements were the provision of evidence-based care to improve the quality of life and reduce disease burden; comprehensive assessment of cough characteristics and treatable traits; careful use of neuromodulators or opioid antitussives; appropriate referral to other specialists; and active participation in research and education. A minimum diagnostic test panel, comprising chest radiography, spirometry, paranasal sinus X-ray, and fractional exhaled nitric oxide measurement/blood eosinophil count, was also established. CONCLUSIONS:This study presents the first national consensus to define the goals and standards of chronic cough clinics in South Korea. The recommendations reflect a balance between internationally suggested approaches and local healthcare realities. This consensus is expected to provide updates to national guidelines, facilitate standardized care, and support future research and educational initiatives in chronic cough.

Summary Racial differences exist in patterns of long‐term condition among adults with asthma. These differences may have implications for asthma management and outcomes.

In the Asia-Pacific region, there is limited data on the full extent of the burden of severe asthma, as well as a lack of clear guidance on improving care standards. Genetic, environmental, behavioural, policy and funding factors in -Asia-Pacific region differ from other parts of the world. To address these gaps, a panel of Asian experts conducted a comprehensive review of the existing literature in the region, aiming to understand the burden of severe asthma and provide key recommendations and actionable steps to improve its management across Asia. Experts identified several key challenges in managing SA, which include inadequate expertise, delayed patient identification or referral, limited access to advanced diagnostics and treatments, suboptimal adherence, and insufficient government support and funding, underlining the need for a more comprehensive approach to SA management. Experts also proposed that the Asia-Pacific region definition of clinical remission in SA should include elimination of exacerbation and use of oral corticosteroids, good symptom control, and inclusion of lung function criteria, particularly in light of the evolving treatment landscape. The experts concluded that while restoring normal lung function may be unrealistic for most patients with severe asthma and remodelled airways, striving for optimal individual lung function or maintaining stability may be a more attainable goal. Several key points and actionable recommendations were proposed to help reduce the overall burden of severe asthma in Asia.

BACKGROUND:Interstitial lung disease (ILD) is a common but serious extra-articular manifestation of rheumatoid arthritis (RA). RA-associated ILD (RA-ILD), which often presents with the usual interstitial pneumonia (UIP) pattern, can resemble idiopathic pulmonary fibrosis (IPF), though the treatment and progression of these two conditions differ. However, the immunologic and molecular mechanisms associated with RA-ILD and IPF development have not been well elucidated at the single-cell level. METHODS:To investigate the underlying mechanisms associated with RA-ILD and IPF development, we performed single-cell RNA sequencing (scRNA-seq) of peripheral blood mononuclear cells (PBMCs) from five RA-ILD patients and five patients with IPF with a matched age and sex distribution. RESULTS:A high-quality scRNA-seq dataset comprising 31,416 peripheral immune cells was generated. Overall immune composition was similar between groups; however, a significant elevation of NK cells was seen among the RA-ILD PBMCs, with increased expression of cytotoxic and inflammation-related genes (GZMB, GZMH, PRF1) as well as interferon‑related genes (STAT1, STAT3, IRF9, IFNG). Myeloid subsets displayed distinct transcriptional programs in IPF and RA-ILD: IPF CD16⁺ monocytes were enriched for TGF‑β-driven fibrotic signaling, whereas RA-ILD monocytes exhibited type I/II interferon pathway activation. Fibrosis‑related genes (TGFB1, SMAD3, SMAD7, TGIF1) were specifically upregulated in IPF. Conclusions:RA‑ILD and IPF share similar peripheral immune cell compositions, but exhibit distinct transcriptional activation patterns. RA‑ILD is characterized by increased NK‑cell-driven cytotoxic and interferon‑related responses, along with interferon‑activated monocytes. In contrast, IPF shows a TGF‑β-dominant fibrotic program, with transcriptional activation of CD16⁺ monocytes and upregulation of fibrosis‑related genes.

Objectives Pulmonary involvement is common in systemic lupus erythematosus (SLE), but the relative risk of pulmonary manifestations in SLE versus non-SLE subjects remains unclear. This study aimed to evaluate the risk of pulmonary manifestations in SLE subjects compared with matched controls.Methods Using data from the Korean National Health Insurance Service (2009–2017), we identified 6074 individuals aged ≥20 years with newly diagnosed SLE and 60 740 matched controls by age and sex (1:10 ratio) who did not have prior pulmonary manifestations.Results Over a mean follow-up of 9.3±2.7 years, the incidence of pulmonary manifestations was 15.2 per 1000 person-years in the SLE cohort and 4.5 per 1000 person-years in the matched cohort. The SLE cohort had a significantly higher risk of pulmonary manifestations (adjusted HR (aHR) 3.26; 95% CI 2.99 to 3.56). The highest risk was observed for pulmonary hypertension (aHR 14.66; 95% CI 9.43 to 22.80), followed by interstitial lung disease (aHR 9.58; 95% CI 7.99 to 11.49), pleural disorders (aHR 3.29; 95% CI 2.84 to 3.81), pulmonary embolism (aHR 2.66; 95% CI 2.06 to 3.43), tuberculosis (aHR 2.35; 95% CI 1.88 to 2.93), acute respiratory distress syndrome and haemorrhage (aHR 1.85; 95% CI 1.51 to 2.25) and lung cancer (aHR 1.41; 95% CI 1.02 to 1.95).Conclusions Subjects with SLE have an approximately 3.3-fold higher risk of pulmonary manifestations compared with matched controls. Notably, the risks of pulmonary hypertension and interstitial lung disease are particularly elevated.

BACKGROUND:Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) has the most disastrous impact on prognosis as a major cause of morbidity and mortality. However, there is no proven treatment, and the occurrence of AE is unpredictable. This study aimed to develop a prediction model for AE in patients with IPF using the nationwide Korea IPF Cohort (KICO) registry. METHODS:This is a retrospective study of Korean patients with IPF who were enrolled from June 2016 to February 2022 in the KICO registry. We developed a prediction model for AE based on risk factors found in the multivariable logistic regression model. RESULTS:Of 678 patients with IPF, the mean age was 69.4 years, and 82.0% were male. AE occurred in 165 patients (24.3%) during follow-up (median: 40.7 months). The median time from IPF diagnosis to AE was 11.6 (interquartile range: 3.6-23.5) months. Lower forced vital capacity (FVC), shorter six-minute walking distance (6MWD), and the use of home oxygen were independently associated with AE in the multivariable logistic analysis. In a risk-predicting model using variables of FVC, 6MWD, and the use of home oxygen, there was a significant predictive power for AE in both score (area under the curve [AUC], 0.746; 95% confidence interval [CI], 0.705-0.783; P < 0.001) and stage (AUC, 0.696; 95% CI, 0.654-0.736; P < 0.001). CONCLUSION:Our results suggest that a model using FVC, 6MWD, and home oxygen use may be useful in predicting AE in patients with IPF.

BACKGROUND:The impact of coronavirus disease 2019 (COVID-19) on stroke risk in adult individuals with asthma post-recovery remains unclear. METHODS:Using a longitudinal retrospective cohort design based on the Korean National Health Insurance Service claims database, we analyzed stroke risk in two parts. Study 1 examined stroke risk in individuals with asthma according to COVID-19 severity, and Study 2 compared stroke risk between individuals with asthma (asthma cohort) and the general population without asthma (general population cohort), considering COVID-19 severity. Both studies used propensity score matching and Cox proportional hazards regression models for risk estimation. RESULTS:In Study 1, which evaluated stroke risk in the asthma cohort, the risk of stroke was significantly higher in the asthma cohort with severe COVID-19 compared to the asthma cohort without COVID-19 (adjusted hazard ratio [aHR], 1.88; 95% confidence interval [CI], 1.02-3.46). In Study 2, which evaluated stroke risk across six groups stratified by asthma status (asthma cohort and general population cohort) and COVID-19 severity (no, non-severe, and severe COVID-19), stroke risk was highest in the asthma cohort with severe COVID-19 (aHR, 3.42; 95% CI, 1.72-6.79, referring to the general population group without COVID-19), suggesting that severe COVID-19 has a more substantial effect on stroke risk in individuals with asthma. CONCLUSION:This study highlights a significant association between severe COVID-19 and stroke occurrence in adults with asthma, emphasizing the need for ongoing stroke monitoring to improve long-term asthma outcomes during the COVID-19 endemic period.