Pulmonary Therapy最新文献

Introduction: Sleep disorders are common yet often underdiagnosed in children with attention deficit/hyperactivity disorder (ADHD). These disturbances can exacerbate ADHD symptoms and negatively affect cognitive, emotional, and behavioral functioning. This study aimed to describe the prevalence of obstructive sleep apnea (OSA) and other sleep disorders in children with ADHD using standardized diagnostic criteria and to identify associated clinical and behavioral factors.

Methods: A cross-sectional study was conducted on 629 children aged 6-12 years (mean age: 7.8 ± 1.5 years) who were diagnosed with ADHD. Sleep disturbances were assessed using the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire (PSQ), and respiratory polygraphy. Sleep disorders were classified on the basis of the International Classification of Sleep Disorders, Third Edition (ICSD-3). Multivariate logistic regression was used to identify associated risk factors.

Results: Sleep disorders were diagnosed in 70.0% of children with ADHD. The most common disorders were insomnia (40.2%), OSA (23.4%), parasomnias (27.8%), restless legs syndrome (10.5%), and delayed sleep-wake phase disorder (4.8%). The inattentive ADHD subtype, psychiatric comorbidities, tonsil and adenoid hypertrophy, iron-deficiency anemia, and sleep-related behaviors in children with ADHD were significantly associated with sleep disturbances.

Conclusions: Sleep disorders are highly prevalent and diverse in children with ADHD. Early identification and targeted management of sleep disturbances, particularly OSA and insomnia, are essential to improving sleep quality and optimizing ADHD outcomes. Routine sleep screening should be integrated into clinical ADHD evaluations. Graphical abstract available for this article.

An indwelling pleural catheter (IPC) is a valuable tool in the management of pleural effusions, allowing drainage strategies to be tailored to match patient-centred goals. Previously, IPCs were primarily utilised in malignant pleural effusion (MPE) in the presence of non-expandable lung (NEL) or after the failure of chemical pleurodesis. Several studies have compared IPC to intercostal chest drain (ICD) with talc pleurodesis (TP), as well as different drainage regimens, resulting in a transition of practice. Continued developments have led to novel adjuncts, such as digital drainage, which allow controlled flow rates. The emerging field of intrapleural therapy in MPE is gaining attention as a potential new treatment modality, possibly increasing the scope of IPCs further. This article will provide a narrative review of the role of IPCs and will be based on published evidence to date and highlight the importance of an individualised, patient-centred care approach.

Introduction: Moderate-severe asthma affects a significant proportion of patients and poses challenges in symptom control and exacerbation prevention. The preferred track 1 endorsed by the Global Initiative for Asthma (GINA) recommendations offers a single-inhaler approach combining inhaled corticosteroids and formoterol for both maintenance and symptom relief (maintenance and reliever therapy; MART). However, MART's real-world adoption remains suboptimal and concerns regarding its correct implementation persist. "What About MART Posology" (WAMP) survey assessed the knowledge and clinical application of MART among Italian healthcare professionals (HCPs) and patients.

Methods: WAMP was a cross-sectional, web-based survey conducted among 1000 Italian HCPs and 400 patients with moderate-severe asthma. HCPs answered questions regarding treatment preferences, adherence to GINA recommendations and MART implementation. Patients reported on their therapeutic regimens, inhaler use, and adherence behaviors.

Results: Most HCPs demonstrated awareness of GINA recommendations. Pulmonologists (73.6%) and allergists (62.0%) reported favoring track 1, while general practitioners (GPs) showed greater variability (55.1%). Most of HCPs reported the use of inhaled corticosteroids (ICS)-formoterol, according to the MART approach, to manage moderate-severe asthma. GPs reported that approximately 45.5% of moderate-severe patients with asthma treated with ICS-formoterol inhaled therapy were also prescribed short-acting β2-agonists (SABA). Among patients, ICS-formoterol was the most reported regimen (59.7%), despite only 21.6% adhered to the MART approach correctly. Triple therapy was preferred for patients with recurrent exacerbations, yet its adoption was lower than expected.

Conclusions: The WAMP survey suggests a strong awareness of GINA track 1 among Italian HCPs. MART was widely implemented, particularly by specialists; patient data supported these findings. Gaps in education on MART's dual function persist though. Targeted training for HCPs and improved patient education are essential to optimize asthma management and adherence to evidence-based strategies.

Pleural infection encompasses a spectrum of disease that can present significant challenges in clinical practice. Despite better understanding of the underlying pathophysiology and microbiology, outcomes for patients remain poor. The use of antibiotics and chest tube drainage continue to be the mainstay of treatment, with surgery often reserved for those not responding to initial medical therapy. However, at present, the optimal management strategy for individual patients-including the role of early surgical and/or intrapleural therapy-is not clear. In this article, we provide an overview of the pathophysiology, diagnosis and management of pleural infection, highlighting current concepts and key practice points to aid the reader in caring for this important and often complex group of patients.

The evidence that tobacco cigarettes are harmful to the health of smokers led to the introduction of electronic nicotine delivery systems (ENDS) as a safer alternative. ENDS, which include electronic cigarettes (e-cigs) and heated tobacco products (battery-operated devices that heat a liquid and produce an aerosol), are portable, cheap, easy-to-use, self-powered devices, and resemble tobacco cigarettes. After an overview of the toxicological, clinical, and epidemiological implications associated with the increasingly widespread use of ENDS, this narrative paper evaluates their role as a smoking cessation aid. Randomized controlled trials show that e-cigs can help in achieving cigarette smoking cessation, but their role in real life is still debated. There is no clear association in current smokers between the prevalence of e-cig use and overall quit rates. Although ENDS are not Food and Drug Administration (FDA)- and European Medicines Agency (EMA)-approved for quitting, they are one of the most widely utilized pharmacological support devices for smoking cessation. Physicians should ask for ENDS use and amount at each visit, be able to advise on how to manage ENDS as an aid for quitting, encourage vapers not to continue their use indefinitely, and explain how to stop ENDS.

Introduction: A common complication of interstitial lung disease (ILD) is pulmonary hypertension (PH), which is associated with increased morbidity and mortality and worsened quality of life. In ILD, evaluating for PH is recommended prior to lung transplantation. However, this is not standardized or routinely performed in earlier stages of ILD, and guidelines lack an evidence-based approach for PH screening in this population. Furthermore, right-heart catheterization (RHC) access can be limited in many settings. The objective of PHINDER (Pulmonary Hypertension Screening in Patients with Interstitial Lung Disease for Earlier Detection) is to prospectively develop screening strategies for PH in patients with ILD.

Methods: PHINDER is a prospective, non-interventional study that will enroll approximately 200 patients with ILD treated in a variety of settings in the United States (community centers, academic institutions, etc.). Patients must be diagnosed with ILD by high-resolution computed tomography (HRCT) and must not have a previously reported mean pulmonary arterial pressure (mPAP) > 20 mmHg. To enrich the population for PH, patients must meet additional criteria on Pulmonary Function Tests, HRCT, signs/symptoms, 6-min walk test, or echocardiography. Patients will undergo a variety of routine ILD clinical assessments. Lastly, patients receive a RHC to assess for PH, defined as mPAP > 20 mmHg with pulmonary arterial wedge pressure ≤ 15 mmHg and a pulmonary vascular resistance > 2 Wood Units. All treatment decisions are at the discretion of the provider and not influenced by study participation.

Planned outcomes: Following study completion, statistical tools will be used to derive a practical model for a screening algorithm using the variables identified in the study as most predictive of PH in patients with ILD.

Conclusions: Using a previously developed list of clinical assessments from PH and ILD experts, the PHINDER study aims to be the first prospectively enrolled study to evaluate prognostic screening strategies that can be used to develop an algorithm to predict the risk of PH in patients with ILD.

Trail registration: NCT05776225.

Introduction: Cystic fibrosis (CF) transmembrane conductance regulator modulators (CFTRm) have transformed CF care, shifting treatment from only managing symptoms to also addressing the underlying defects that cause CF. CFTRm first entered clinical practice in 2012 and was followed by additional CFTRm combinations-including the approval of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) in 2019-which treats most CF genotypes.

Methods: We identified peer-reviewed literature for a narrative review (January 1990 to January 2025) describing longitudinal trends in CF survival and age of death and assessing the influence of CFTRm, particularly ELX/TEZ/IVA. To supplement the existing literature, a secondary analysis of historical, longitudinal trends in the United States CF Foundation Patient Registry (U.S. CFFPR, 1990-2023) was conducted using recent available data.

Results: Quantitative data from published studies show that the median age of survival and death increased over time but with varying magnitudes across regions. Most cohort and registry-based studies were conducted in settings where CFTRm were not yet widely available, limiting the evaluation of CFTRm effects on survival trends over time. In the secondary U.S. CFFPR analysis, the median survival age increased from 29.0 years in 1990 to 38.6 years in 2012 prior to the introduction of CFTRm and to 68.0 years in 2023, demonstrating substantial improvement following the introduction of CFTRm. Linear regression analyses showed gains in median survival age increased from 0.48 years per year prior to CFTRm to 4.79 years per year after approval of ELX/TEZ/IVA in 2019.

Conclusions: Study results provide initial evidence of the impact of CFTRm to meaningfully improve survival. Longer-term follow-up data across geographies will provide a deeper understanding of the full impact of CFTRm on predicted CF survival and mortality.

Respiratory infections are a major cause of mortality among young children and adults, particularly the elderly or those with underlying medical conditions. Many respiratory infections, including influenza, COVID-19, pneumococcal disease, and respiratory syncytial virus (RSV), have available vaccines and antiviral agents. However, vaccine coverage rates remain low. Experts representing a broad spectrum of medical specialties from the United Arab Emirates (UAE) made evidence-based recommendations on treating patients considered high risk for respiratory infections, highlighting gaps in current practices and suggesting strategies for improved communication between healthcare professionals and patients. To effectively manage respiratory infections, the experts emphasized the importance of adhering to guidelines, considering all vaccines and antiviral treatments, and strictly following vaccination schedules. Early testing upon recognition of symptoms was also encouraged. Improving vaccine uptake was considered crucial and could be achieved by educating patients about disease prevention through vaccines and the role of antiviral treatments for COVID-19. Addressing knowledge gaps and combating vaccine hesitancy among both patients and healthcare professionals were also essential steps. Recommendations for future initiatives include healthcare professionals educating the public on precautionary measures to reduce the spread of respiratory infections. Additionally, the experts agreed that clinical management guidelines for chronic diseases should be updated to include preventative strategies such as vaccines, prophylaxis, and counselling. Monitoring the performance of healthcare facilities using key performance indicators is also recommended to ensure effective management and continuous improvement of vaccination programs. Patient populations in the UAE who are considered at high risk of serious disease from respiratory infections have diverse medical needs and may access healthcare across a wide range of settings and specialisms. Therefore, it is vital that all healthcare professionals across specialisms who may engage with these individuals are able to provide appropriate advice on managing the risk through vaccination, prompt testing, and treatments as needed.

In this concise article, we give a current overview of the practical approach to diagnosing pleural mesothelioma (PM). PM is a rare, incurable, aggressive cancer almost exclusively related to previous asbestos exposure. We begin by outlining the general approach to pleural malignancy. The focus then shifts to pleural mesothelioma (PM), with discussions on cytological analyses, a direct-to-thoracoscopy approach, specialist services, and future directions. This narrative review aims to provide an updated, practical overview of current and emerging diagnostic strategies.

Introduction: Responder analyses provide information about characteristics associated with therapeutic benefits. Short-term responses may predict long-term benefits. We evaluated responders, clinically important improvement (CII), disease stability (DS), and the relation of short- to long-term responses in patients with chronic obstructive pulmonary disease (COPD) in ELLITHE.

Methods: ELLITHE was a multicenter, open-label, non-interventional effectiveness study between 2020 and 2022 evaluating the effects of treatment initiation with once-daily single-inhaler triple therapy (odSITT) FF/UMEC/VI (100/62.5/25 µg via ELLIPTA) on COPD Assessment Test (CAT), forced expiratory volume in 1 s (FEV₁), and exacerbations over 12 months. Post hoc responder analyses for CAT (≥ 2 units improvement), FEV₁ (≥ 100 ml change), and exacerbations (no event) were performed. Composite endpoints CII and DS (CII = response to at least two outcomes; DS = absence of clinically important deterioration for all outcomes) were also evaluated.

Results: A total of 786 patients had available data for any analysis. At study completion, 53.3% of patients were CAT, 36.7% FEV₁, and 90.2% exacerbation responders, with 22.1% responding to all outcomes; 64.3% had a CII, and 52.7% showed DS. CII and DS were more frequent in subjects with higher baseline CAT score, and DS in patients  on prior ICS/LABA therapy (all p < 0.05). Early (3 months) CAT, FEV₁ and CII response strongly predicted respective responses at study end (odds ratios = OR ranging from 6.3 to 7.4), and DS (OR from 3.0 to 4.2). In the patient subset with available baseline eosinophil counts, response was generally similar at < 150 versus ≥ 150 cells/μl.

Conclusions: Despite overlapping responses to single and composite outcomes with odSITT, individual patterns support a multidimensional approach to evaluate benefits in COPD. Responders had higher baseline CAT scores and frequency of prior dual therapies. Short-term responses of FEV₁ and/or CAT were reasonable predictors of long-term responses, including DS. DS was achievable for the majority of patients and may represent a useful outcome for future COPD research and management.