Multidisciplinary Respiratory Medicine最新文献

Background: Rhinitis is a common medical condition characterized by different phenotypes. Allergic (AR) and non-allergic (NAR) rhinitis share common type 2 inflammation. The present Italian educational activity investigated the clinical characteristics and treatments of patients with rhinitis managed by Italian otorhinolaryngologists.

Methods: Globally 117 well-matched otorhinolaryngologists attended this educational activity. This initiative consisted of a preliminary questionnaire to participants, one educational webinar, a field training session, and one in-person meeting. Demographic and clinical parameters, and treatments (previous and current) were collected.

Results: The otorhinolaryngologists collected data of 1238 patients with rhinitis (814 with AR and 424 with NAR). Nasal obstruction was the most common symptom, present in 88% of patients. Quality of life was impaired in about 80% of patients. Concomitant presence of nasal obstruction and impaired quality of life was associated with more severe symptoms. Intranasal corticosteroids (INCS) were the preferred treatment for participants. This educational initiative changed participants' attitudes and increased the percentage of INCS prescriptions, mainly for budesonide, and the use of INCS cycles.

Conclusions: The present iterative educational initiative yielded practical insights into the clinical characteristics of patients with type 2 rhinitis. Nasal obstruction and impaired quality of life are common clinical characteristics among patients visited. A close link between inflammation and associated symptoms justifies the frequent use of INCS. In this context, budesonide was perceived as a valuable option in managing AR and NAR patients.

Background: Electronic cigarettes are widely used, and healthcare providers play an important role in advising patients about their safety and possible use in smoking cessation. However, differences in knowledge, attitudes, and confidence may affect the consistency and quality of counseling.

Aim: This systematic review examined evidence on knowledge, attitudes, confidence, and information sources related to electronic cigarettes among healthcare providers and medical students.

Methods: A search of PubMed and Scopus was conducted for English-language studies published within the past 10 years. Quantitative, qualitative, and mixed-methods observational studies were included, and findings were synthesized narratively due to methodological differences across studies.

Results: Fourteen studies met the inclusion criteria. Although awareness was generally high (up to 79.3%), detailed knowledge was often limited. In Europe, about half of physicians rated their understanding as moderate, and 96.5% of Polish physicians considered e-cigarettes harmful, with only 11.5% supporting their use for smoking cessation. In the Middle East, fewer than 15% viewed them as safer than conventional cigarettes. Among students, 30-36% selected "don't know" when asked about safety.

Conclusion: Confidence in counseling varied and was typically lower among students. Media and social networks were the most common sources of information. Despite high awareness, important knowledge gaps remain, highlighting the need for structured education and clearer clinical guidance.

Introduction: Silicosis is a well-recognised occupational lung disease caused by inhalation of crystalline silica dust; however, extrapulmonary involvement, particularly splenic silicosis, remains rare and underreported in the literature.

Case presentation: A 46-year-old female sand sifting machine operator presented with six years of occupational silica exposure at a sand classification and packing factory. In 2005, she developed respiratory symptoms, and chest radiography revealed diffuse nodular opacities, although silicosis was not diagnosed at that time. In October 2024, approximately 19 years after initial presentation, computed tomography demonstrated multiple calcified pulmonary nodules, progressive massive fibrosis, eggshell calcification of mediastinal lymph nodes, and multiple calcified micronodules throughout the splenic parenchyma. Based on these characteristic radiological findings and her occupational exposure history, a diagnosis of complicated silicosis with extrapulmonary splenic involvement was established. Despite a latency period shorter than the traditionally reported 10-30 years for chronic silicosis, the clinical course was indolent across the interval between the two assessments (2005 and 2024), which may lie near the boundary between chronic and accelerated forms.

Conclusions: Splenic silicosis should be considered in patients with occupational silica exposure who present with splenic calcifications. Although sand sifting operations have received limited attention as a potential source of silica exposure, the occurrence of multiple cases at the same facility suggests potentially high exposure intensity. These findings emphasise the importance of comprehensive prevention strategies and raise the question of whether earlier initiation of health surveillance may benefit workers in sand processing industries.

Recupera e Respira, a pilot project launched in the Friuli Venezia Giulia region in Italy in 2022, addresses the environmental impact of improper disposal of respiratory inhalers. When these medical devices are disposed of as regular household waste without segregation, they contribute to pollution with aluminum and plastic, and emission of residual hydrofluoroalkane (HFA). In collaboration with Federfarma, the national association representing over 19,000 private pharmacies affiliated with Italy's National Health Service, and with the support of Assinde, a company specializing in pharmaceutical returns management and the safe disposal of expired or unused medicines, Chiesi Italy suggested and implemented an institutionally approved collection and disposal system for empty inhalers. This initiative achieved a recovery rate of 24.6% over 3 years (calculated from IQVIA sell-out data referring to the Friuli Venezia Giulia region for September 2022 to June 2025), collecting over 111,000 inhalers from regional pharmacies. Proper disposal occurred at certified facilities capable of neutralizing hazardous components at high temperatures. The project highlights the role of pharmacies in educating patients and facilitating sustainable healthcare practices. An increase in recovery rates from 22.6% to 27.3% was observed in the first 2 years of project, with a sightly decrease over the third year. Overall, this study demonstrates the model's potential scalability, aligning with Chiesi's net zero goals by 2035. The study highlights how innovative waste management systems can effectively reduce the environmental burden of inhalers and foster public engagement in sustainability.

Background: Tobacco-related small-airway dysfunction (SAD) may precede spirometric obstruction. The single-breath nitrogen washout (SBW N₂) captures ventilation heterogeneity and may detect early peripheral airway involvement through the phase III slope (ΔN₂/L) and closing volume (CV).

Aim: To describe SBW N₂ indices in smokers with preserved spirometry, examine their relationship with cumulative smoking exposure, and contextualise results against published reference (healthy predicted) values.

Methods: Cross-sectional study of current smokers (n=90) with preserved spirometry (pre-bronchodilator FEV1/FVC ≥0.70). Spirometry followed SEPAR criteria and SBW N₂ followed ERS/ATS recommendations. Associations with pack-years were assessed by Pearson correlations and linear regression. In the absence of a concurrently recruited healthy control group, SBW N₂ outcomes were also expressed as percent-predicted using published reference equations (ΔN₂/L and CV/VC in males aged 30-70 years). To explore sex-related differences in ventilation heterogeneity, we compared key characteristics and size-independent functional indices between men and women (spirometry as % predicted and ratios) and fitted a multivariable OLS model for ΔN₂/L adjusting for pack-years, age and BMI.

Results: Mean age was 42 (11) years and mean smoking exposure 29.01 (16.95) pack-years. Mean ΔN₂/L was 2.674 (1.424) %N2•L⁻¹ and correlated significantly with pack-years (r=0.452, p<0.0001), as did CV/VC (r=0.389, p=0.00015). In external-reference comparisons, ΔN₂/L in males aged 30-70 years (n=42) was markedly elevated (327.1 (165.7)% predicted; p<0.0001), with 83.3% exceeding the proposed ULN (180% predicted). In multivariable regression adjusting for pack-years, age and BMI, male sex remained independently associated with higher ΔN₂/L (β=+0.946 %N2•L⁻¹; 95% CI 0.400 to 1.492; p<0.001).

Conclusions: SBW N₂ indices-particularly ΔN₂/L-show a dose-response relationship with smoking burden and are markedly abnormal relative to healthy predicted values, even in smokers with preserved spirometry. These findings support SBW N₂ as a sensitive tool for detecting early peripheral SAD before spirometric obstruction becomes apparent. Sex-related differences in ΔN₂/L persisted after adjustment for smoking exposure and anthropometrics, suggesting that sex should be considered when extrapolating male-based reference contextualisation to women.

Background: Coexistence of interstitial lung disease (ILD), particularly idiopathic pulmonary fibrosis (IPF), and lung cancer poses major diagnostic and therapeutic challenges, yet clinical management remains heterogeneous. The project aims to describe current Italian practices for integrated management of ILD with concomitant lung cancer.  Methods: ICARO (Interstiziopatia e Cancro del polmone: AppRoccio al management clinico integratO) is a national cross-sectional clinician survey conducted in Italy on behalf of the Italian Respiratory Society from  November 2024 to March 2025. A 12-item multiple-choice questionnaire assessed diagnostic strategies, treatment preferences, and perceived toxicity risks. Invitations were sent to X physicians, among which 38 ansewered (35 specialists and senior 3 registrars (age range: 28-68 years).  Results: An ILD multidisciplinary team was available in 26/38 (71.1%) centres. Diagnostic procedures for lung cancer in ILD patients were reported as performed "always/often" by 14/38 (36.8%), with the main concern being ILD progression after procedures (31/38 - 81.6%). Most respondents continued antifibrotic therapy during systemic cancer treatment (28/38- 73.7%). Combined chemotherapy plus immune checkpoint inhibitors was perceived as the highest-risk regimen by 19/38 physicians (50%), and 20/38 (52.6%) were hesitant to offer neoadjuvant immunotherapy in stage II-IIIa NSCLC. Severe toxicity from radiotherapy was reported as frequent by 8/38 (21.1%).  Conclusions: Italian clinicians report substantial variability in diagnostic and therapeutic strategies for lung cancer in ILDs, driven mainly by concern for ILD progression and treatment-related pulmonary toxicity. Although limited, this study unveils an urgent need for further prospective studies to better define the safety and efficacy of combined therapeutic approaches and to establish evidence-based guidelines to support clinical decision-making.

Electronic nose (e-nose) technology, as an emerging non-invasive diagnostic tool, has demonstrated considerable potential in the diagnosis and management of bronchial asthma. By mimicking the human olfactory system, this technology utilizes gas sensor arrays combined with pattern recognition algorithms to enable rapid analysis and identification of volatile organic compounds (VOCs) in the exhaled breath of patients with asthma. Accumulating evidence suggests that e-nose systems can discriminate between asthma patients and healthy individuals with relatively high accuracy, and they have also shown promising performance in asthma phenotyping. Compared with conventional pulmonary function tests, e-nose technology offers distinct advantages, including cost-effectiveness, rapid response, and non-invasiveness. These features make it particularly suitable for populations requiring repeated dynamic assessment or those unable to perform high-quality pulmonary function testing. However, current evidence is primarily derived from exploratory studies, and heterogeneity exists across studies in terms of population characteristics and methodologies. This highlights the need for further standardized research to improve the consistency and reproducibility of findings.

Objective: To provide a structured narrative review of current evidence and future directions for artificial intelligence (AI) applications in the tertiary prevention of lung cancer, with a focus on radiology-driven recurrence surveillance, treatment response assessment, prognostic stratification, and real-world clinical implementation.

Methods: A narrative review was conducted using PubMed, Embase, Web of Science, and IEEE Xplore databases, covering studies published between January 2019 and March 2024. Search terms included lung cancer, tertiary prevention, radiomics, deep learning, recurrence, treatment response, and survival prediction. Studies were selected based on relevance to post-diagnosis clinical management, availability of quantitative performance metrics, and clarity of validation strategy. AI methodologies evaluated included radiomics, convolutional neural networks (CNNs), transformer-based temporal models, ensemble learning, and multimodal data integration. Evidence was critically appraised with respect to study design, cohort size, validation approach, and clinical applicability.

Results: Across tertiary-prevention tasks-particularly recurrence detection, treatment response monitoring, and survival prediction-AI-assisted models demonstrate performance improvements over conventional radiological assessment in selected, well-defined scenarios, especially when multimodal imaging and external validation are employed. Reported AUC values for recurrence and response prediction generally range from 0.75 to 0.92, though results remain heterogeneous. Radiomics-deep learning integration and ensemble models show the most consistent gains, while evidence for immunotherapy response prediction and long-term survival modeling remains limited by small cohorts and lack of prospective validation. Key barriers include data heterogeneity, limited interpretability, regulatory constraints, and integration into clinical workflows.

Conclusions: AI has the potential to meaningfully support tertiary prevention of lung cancer by enhancing surveillance accuracy, treatment monitoring, and prognostic assessment. However, clinical adoption requires rigorous external validation, standardized imaging and data pipelines, transparent model behavior, and alignment with evolving regulatory frameworks. With continued multidisciplinary collaboration and quality assurance, AI is likely to become an integral adjunct to radiological practice in personalized lung cancer management.

Introduction: Granulomatous lymphocytic interstitial lung disease (GLILD) is a non-infectious complication affecting 10-20% of patients with common variable immunodeficiency disorders. Exercise capacity in GLILD patients, who often report shortness of breath during exercise, has not been previously evaluated. This study aimed to assess the utility of the six-minute walk test (6MWT) as an outcome measure in GLILD. It also evaluated reproducibility and effectiveness of King's Brief ILD Questionnaire (K-BILD) questionnaire in capturing the multidimensional impact of GLILD on quality of life.

Methods: This was an observational prospective cohort study. The 6MWT and questionnaires were conducted at baseline and two follow-ups. The 6MWT was performed according to ERS/ATS guidelines. The utility was evaluated by correlating the 6MWT measures (walked distance (6MWD) and distance-saturation product (DSP)) with clinical parameters and health-related quality of life (HRQOL) questionnaires. Reproducibility was assessed using the Intraclass Correlation Coefficient.

Results: Thirteen participants (54% male, median age 45 (IQR 38- 62) years) were included. The median 6MWT distance was 457 meters. DSP was the only measure strongly correlated with FVC% and FEV1%, and it showed stronger correlations with clinical measures than 6MWD. The 6MWT has good 6-month and one year reproducibility. Finally, K-BILD appeared to be a useful tool for assessing HRQOL in patients with GLILD, who often have multi-system involvement.

Conclusion: Our findings highlight the potential of the 6MWT as a useful measure to assess GLILD. The 6MWT and K-BILD correlations with clinical parameters suggest utility in assessing disease severity and monitoring patients' physical functioning.

Background: Many transcription factors may be involved in the pathogenesis of pulmonary fibrosis (PF). One such factor is PPARG. The PPARG agonist, pioglitazone (PG), has demonstrated general lung protective activity in animal models and is considered a promising therapeutic agent for fibrotic intervention. This study aimed to investigate the effect of PG on the expression of connective tissue remodeling genes in the lungs using bleomycin (BLM)-induced lung fibrosis (BIF).

Methods: The study was conducted on male BALB/c mice. PF was induced by pretreatment with bleomycin sulfate and cyclophosphamide. The mice were randomly divided into 3 groups: the first group was administered BLM at a dose of 0.15 U/kg in 50 µl of sterile saline (0.9% NaCl), and the second group was administered 50 µl of saline. The third group was not induced with pulmonary fibrosis and served as a control group. On the 4th day of the experiment, animals from the first and second groups were randomly divided into animals that received PG orally at a dose of 20 mg/kg or saline (40 µl) for 14 days. 4-hydroxyproline was determined in right lung tissue samples. Gene expression was determined using real-time PCR.

Results: PG administration to BIF mice resulted in a significant reduction and normalization of the total number of BAL cells, fibrosis score, mRNA expression of genes associated with connective tissue - Col1a1 (P=0.0466), Col3a1 (P=0.0053), Mmp2 (P=0.0006), Tgfb2 (P=0.0459), and Tgfb3 (P=0.0017), as well as mRNA of genes regulating lung connective tissue inflammation and fibrosis - Mrc1 (P=0.0263), Edn1 (P=0.0012), Pparg (P=0.0044), Nr1d1 (P=0.0053) and Fn1 (P=0.0125).

Conclusions: PPARG activation by PG alleviates BIF by decreasing collagen deposition, Col1a1 and Col3a1 mRNA expression, remodeling of lung tissue (decreasing Mmp2, Edn1, and Fn1 mRNA), and M2-specific profibrotic macrophage Mrc1 mRNA.