Advances in Respiratory Medicine

40 pages, 1652 KB

Open AccessReview

Leveraging Artificial Intelligence for the Diagnosis of Systemic Sclerosis Associated Pulmonary Arterial Hypertension: Opportunities, Challenges, and Future Perspectives

by Samiksha Jain, Avneet Kaur, Abdul Qadeer, Victor Ghosh, Shivani Thota, Mallareddy Banala, Jieun Lee, Gayathri Yerrapragada, Poonguzhali Elangovan, Mohammed Naveed Shariff, Thangeswaran Natarajan, Jayarajasekaran Janarthanan, Jayavinamika Jayapradhaban Kala, Samuel Richard, Saai Poornima Vommi, Shiva Sankari Karuppiah, Anjani Muthyala, Vivek N. Iyer, Scott A. Helgeson, Dipankar Mitra and Shivaram P. Arunachalam Show full author list Hide full author list

Adv. Respir. Med. 2025, 93(5), 47; https://doi.org/10.3390/arm93050047 - 17 Oct 2025

Cited by 1 | Viewed by 1336

Abstract

Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a life-threatening vascular complication of SSc, marked by high morbidity and mortality. Early diagnosis remains a major challenge due to nonspecific symptoms and the limitations of conventional tools such as echocardiography (ECHO), pulmonary function tests (PFTs), [...] Read more.

Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a life-threatening vascular complication of SSc, marked by high morbidity and mortality. Early diagnosis remains a major challenge due to nonspecific symptoms and the limitations of conventional tools such as echocardiography (ECHO), pulmonary function tests (PFTs), and serum biomarkers. This review evaluates the emerging role of artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), in improving the diagnostic landscape of SSc-PAH. A comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, Embase and Google Scholar to identify studies involving AI applications in SSc, pulmonary arterial hypertension (PAH), and their intersection. Evidence indicates that AI models can assist interpretation across modalities, including heart sounds, ECGs, chest X-rays (CXRs), ECHOs, CT pulmonary angiography (CTPA), and omics-based biomarkers. While several models show encouraging diagnostic performance, their accuracy varies by dataset and modality, and most require external validation against right heart catheterization (RHC)-confirmed cohorts. Integrating multimodal data through AI frameworks may enhance early recognition and individualized risk stratification; however, these tools remain exploratory. Future work should emphasize harmonized hemodynamic definitions, transparent validation protocols, and SSc-specific datasets to ensure clinical applicability and reproducibility. Full article

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15 pages, 1376 KB

Open AccessArticle

Beyond the Apnea–Hypopnea Index: Exploring Time-Dependent Hazard Ratios of Respiratory Events in Obstructive Sleep Apnea

by Wojciech Kuczyński, Aleksandra Kudrycka, Karol Pierzchała, Izabela Grabska-Kobyłecka, Michael Pencina, Sebastian Sakowski and Piotr Białasiewicz

Adv. Respir. Med. 2025, 93(5), 46; https://doi.org/10.3390/arm93050046 - 16 Oct 2025

Viewed by 1111

Abstract

Obstructive sleep apnea (OSA) is associated with increased risks of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify [...] Read more.

Obstructive sleep apnea (OSA) is associated with increased risks of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify and compare respiratory predictors of all-cause mortality over 5, 10, and 15 years. A single-center study was conducted at a Sleep Medicine Department between 2005 and 2019, 4025 patients with suspected OSA who underwent polysomnography were admitted, 853 died during the study. We performed Cox regression analyses with dynamic hazard ratios to evaluated predictors of mortality. Prevalence of OSA was high—75.6% in the cohort: 929 patients with mild OSA (23.1%), 770 with moderate OSA (19.1%), and 1343 with severe OSA (33.4%). Survival rates were 89.7%, 81.9%, and 78.8% at 5, 10, and 15 years, respectively. Cardiovascular causes dominated mortality (33.3%), followed by cancer (26.5%). AHI_REM was associated with higher mortality risk in 0–5, 0–10, 0–15 years of observation in contrast to AHIN_REM and AHI_TST. The hazard ratio analysis showed that mortality risk changed over time depending on sleep stage and event type: risk increased for AHI_REM and AHI_TST, while it stayed the same or decreased for AHI_NREM and most central apneas. Full article

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3 pages, 373 KB

Open AccessCorrection

Correction: Román-Ríos et al. RSPH4A-PCDx: An Index to Predict Lung Function Decline in Primary Ciliary Dyskinesia. Adv. Respir. Med. 2025, 93, 27

by Gabriel Román-Ríos, Gabriel Rosario-Ortiz, Marcos J. Ramos-Benitez, Ricardo A. Mosquera and Wilfredo De Jesús-Rojas

Adv. Respir. Med. 2025, 93(5), 45; https://doi.org/10.3390/arm93050045 - 15 Oct 2025

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Abstract

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13 pages, 557 KB

Open AccessArticle

Pressurized Metered-Dose Inhaler Versus Dry Powder Inhaler Adherence Among Individuals with Asthma and COPD

by Dekel Shlomi, Bernice Oberman, Yehonatan Halevy, Shiri Kushnir, Hadas Meir and Yael Reichenberg

Adv. Respir. Med. 2025, 93(5), 44; https://doi.org/10.3390/arm93050044 - 11 Oct 2025

Viewed by 1477

Abstract

Background: The core management of most individuals with asthma and COPD is daily treatment with inhalers such as inhaled corticosteroids (ICS) and long-acting bronchodilators. The two main types of inhalers used are pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Different studies [...] Read more.

Background: The core management of most individuals with asthma and COPD is daily treatment with inhalers such as inhaled corticosteroids (ICS) and long-acting bronchodilators. The two main types of inhalers used are pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Different studies have shown low adherence to inhaler treatments among subjects with asthma and COPD. In this study, we explored the differences in adherence between pMDIs and DPIs of combined ICS and long-acting β₂-agonist inhalers (ICS + LABA) in a large cohort, free from commercial biases. Methods: In this historical prospective study, we included all adult subjects with asthma and/or COPD who acquired at least one ICS + LABA inhaler between 2016 and 2019. We carried out propensity score matching and then compared the maximal number of pMDIs and DPIs purchased in any continuous 12 months during the study period. We also compared once-a-day DPIs with twice-a-day DPIs. Results: Of the 36,998 matched subjects, 5897 (15.9%) purchased pMDIs. The overall median [IQR] inhalers purchased for pMDIs and DPIs were 1 [1, 4] and 3 [1, 8], respectively; for subjects with asthma, 1 [1, 3] and 2 [1, 6]; for subjects with COPD, 1 [1, 3] and 3 [1, 10]; and for subjects with asthma–COPD overlap, 2 [1, 7] and 6 [2, 12]. For all the comparisons, p < 0.001. The once-a-day DPI group had a slight but significantly better adherence than the twice-a-day DPI group. Conclusions: For ICS + LABA therapy, the number of DPIs purchased was significantly greater than the number of pMDIs purchased, as well as the once-a-day DPI relative to the other DPIs. Overall, subjects with asthma and/or COPD had low adherence to all inhalers, with the highest adherence observed among subjects with asthma–COPD overlap. Full article

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19 pages, 650 KB

Open AccessArticle

The Effort, Dyspnea, and Cooperation Scores in Mild and Moderate Post-COVID-19 Patients: Results of a Retrospective Study

by Ovidiu Cristian Chiriac, Corina Sporea, Daniela Miricescu, Ana Raluca Mitrea, Ileana Adela Vacaroiu, Raluca Grigore and Adriana Sarah Nica

Adv. Respir. Med. 2025, 93(5), 43; https://doi.org/10.3390/arm93050043 - 7 Oct 2025

Cited by 1 | Viewed by 813

Abstract

COVID-19 signs and symptoms varied among patients, with the most common being fever, fatigue, sore throat, cough, anorexia, and shortness of breath. (1) Background: This study aimed to assess effort, dyspnea, and cooperation scores in patients with mild and moderate post-COVID-19 forms, both [...] Read more.

COVID-19 signs and symptoms varied among patients, with the most common being fever, fatigue, sore throat, cough, anorexia, and shortness of breath. (1) Background: This study aimed to assess effort, dyspnea, and cooperation scores in patients with mild and moderate post-COVID-19 forms, both at baseline and after completing a structured physical recovery program. (2) Methods: Our study included 160 post-COVID-19 patients who had experienced mild or moderate disease. (3) Results: Effort and dyspnea scores were significantly lower (p < 0.01), while cooperation scores were significantly higher after the rehabilitation program. Both men and women demonstrated significant increases in cooperation scores after recovery. Additionally, both groups showed statistically significant reductions in effort and dyspnea scores (p < 0.001). Among patients aged under and over 60 years, effort and dyspnea scores decreased after rehabilitation, and cooperation scores increased significantly (p < 0.001). No statistically significant differences were observed between genders in any of the three scores. Similarly, no significant differences by age were found in cooperation or dyspnea scores. A significant negative correlation was observed between cooperation and effort scores: patients with higher cooperation scores tended to report lower effort scores, and vice versa (p < 0.001, R = −0.571). (4) Conclusions: The improved cooperation demonstrated by patients during the physical recovery program was significantly associated with reductions in perceived effort and dyspnea, indicating a positive impact on post-COVID-19 rehabilitation outcomes. Full article

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12 pages, 262 KB

Open AccessArticle

Usefulness of Blood Biomarkers in Screening Patients with Obstructive Sleep Apnea: Could Albumin Indices and Uric Acid-to-HDL Ratio Be New OSAS Severity Indices?

by Mihrican Yeşildağ and Taha Tahir Bekçi

Adv. Respir. Med. 2025, 93(5), 42; https://doi.org/10.3390/arm93050042 - 7 Oct 2025

Viewed by 613

Abstract

Background and Objectives: Hematological parameters are increasingly being investigated as readily accessible biomarkers for the diagnosis of obstructive sleep apnea syndrome (OSAS). In our study, we aimed to investigate the relationship between OSAS and albumin indices and the uric acid-to-HDL ratio (UHR). Methods: [...] Read more.

Background and Objectives: Hematological parameters are increasingly being investigated as readily accessible biomarkers for the diagnosis of obstructive sleep apnea syndrome (OSAS). In our study, we aimed to investigate the relationship between OSAS and albumin indices and the uric acid-to-HDL ratio (UHR). Methods: The demographic and laboratory data and AHI (apnea–hypopnea index) values of 613 patients who underwent polysomnography were obtained retrospectively from their files. Blood parameters such as white blood cells (WBCs), red blood cell distribution width (RDW), red blood cells (RBCs), hemoglobin (Hb), hematocrit (Hct), platelets (PLTs), C-reactive protein (CRP), albumin, blood urea nitrogen (BUN), and high-density lipoproteins (HDLs) were obtained from the files. Laboratory indices such as the BUN-to-albumin ratio (BAR), neutrophil-to-albumin ratio (NAR), RDW-to-albumin ratio (RAR), CRP-to-albumin ratio (CAR), and UHR were calculated. OSAS was categorized as simple snoring (SS) (control) (AHI < 5), mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30). The patients were also grouped as severe (AHI ≥ 30) and non-severe (5 > AHI < 30) OSAS and compared in terms of laboratory parameters and indices. Results: Of the 613 participants, 366 (59.7%) were men, and the average age of participants was 55.22 ± 11.13 years. The biomarkers such as RBCs, Hb, Htc, CRP, BUN, creatinine, uric acid, HDLs, CAR, RAR, BAR, and UHR showed significant differences between OSAS patients and controls. WBCs, basophils, RBCs, RDW, Htc, PLTs, HDLs, uric acid, RAR, NAR, and UHR indices were significantly different between the severe OSAS and non-severe OSAS groups (p < 0.05). BAR (OR = 1.151; CI = 1.056 − 1.256; p = 0.001) and UHR (OR = 2.257; 95% CI = 1.507 − 3.382; p < 0.001) were the most important indices predicting OSAS, while RAR (OR = 1.844; CI = 1.224 − 2.778; p = 0.003) and UHR (OR = 2.203; 95% CI = 1.496 − 3.243; p < 0.001) were the strongest indices associated with severe OSAS. Conclusion: In our study, RAR, BAR, and UHR indices were closely associated with the presence and severity of OSAS. These indices can be considered low-cost, readily available methods for predicting OSAS patients. Full article

11 pages, 354 KB

Open AccessArticle

Development of a Tool to Assess the Severity of Pulmonary Hypertension in Patients with Interstitial Lung Disease: A Guide to Assist Therapeutic Choices

by Garrett Fiscus, Chebly Dagher, David O’Sullivan, Brett Carollo, Kristen Swanson, Harrison W. Farber and Raj Parikh

Adv. Respir. Med. 2025, 93(5), 41; https://doi.org/10.3390/arm93050041 - 6 Oct 2025

Viewed by 688

Abstract

Background: Pulmonary hypertension (PH) is a frequent complication in patients with interstitial lung disease (ILD); its occurrence results in significant morbidity and mortality. Currently approved treatment options for PH-ILD include inhaled prostacyclin therapy, although this approach may be insufficient in patients who have [...] Read more.

Background: Pulmonary hypertension (PH) is a frequent complication in patients with interstitial lung disease (ILD); its occurrence results in significant morbidity and mortality. Currently approved treatment options for PH-ILD include inhaled prostacyclin therapy, although this approach may be insufficient in patients who have developed simultaneous right ventricular failure. Moreover, there is no available treatment algorithm regarding the optimal therapy and timing of lung transplant referral for PH-ILD patients based on disease severity. Design/Methods: In this study, we created such a tool to guide PH-specific therapy in PH-ILD patients, especially as further treatment strategies are developed. We developed a 4-point PH-ILD Severity score that integrated both subjective and objective information (WHO FC, CI, TAPSE, PVR) from retrospective analysis of 57 PH-ILD patients. Results: A score of 3 or greater in the PH-ILD Severity score yielded an AUC of 0.831 (p < 0.001) for the composite endpoint of clinical worsening (hospitalization due to a cardiopulmonary indication; decrease in 6 min walk distance by >15% at 2 consecutive visits; all-cause mortality; lung transplantation). Conclusions: Further confirmation and evolution of this PH-ILD Severity score will assist in the development of optimal treatment plans in ILD patients diagnosed with concomitant PH. Full article

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13 pages, 7049 KB

Open AccessArticle

Real-World Efficacy of Beclomethasone Dipropionate/Formoterol Fumarate/Glycopyrronium on Diaphragmatic Workload Assessed by Ultrasound and Lung Function in Patients with Uncontrolled Asthma

by Antonio Maiorano, Anna Ferrante Bannera, Chiara Lupia, Daniela Pastore, Emanuela Chiarella, Giovanna Lucia Piazzetta, Angelantonio Maglio, Alessandro Vatrella, Girolamo Pelaia and Corrado Pelaia

Adv. Respir. Med. 2025, 93(5), 40; https://doi.org/10.3390/arm93050040 - 1 Oct 2025

Viewed by 1067

Abstract

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on [...] Read more.

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV₁ (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF_25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (R_tot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV₁, FEF_25–75, and R_tot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up. Full article

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23 pages, 3811 KB

Open AccessArticle

NSCLC EGFR Mutation Prediction via Random Forest Model: A Clinical–CT–Radiomics Integration Approach

by Anass Benfares, Badreddine Alami, Sara Boukansa, Mamoun Qjidaa, Ikram Benomar, Mounia Serraj, Ahmed Lakhssassi, Mohammed Ouazzani Jamil, Mustapha Maaroufi and Hassan Qjidaa

Adv. Respir. Med. 2025, 93(5), 39; https://doi.org/10.3390/arm93050039 - 26 Sep 2025

Viewed by 1155

Abstract

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. Accurate determination of epidermal growth factor receptor (EGFR) mutation status is essential for selecting patients eligible for tyrosine kinase inhibitors (TKIs). However, invasive genotyping is often limited by tissue accessibility [...] Read more.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. Accurate determination of epidermal growth factor receptor (EGFR) mutation status is essential for selecting patients eligible for tyrosine kinase inhibitors (TKIs). However, invasive genotyping is often limited by tissue accessibility and sample quality. This study presents a non-invasive machine learning model combining clinical data, CT morphological features, and radiomic descriptors to predict EGFR mutation status. A retrospective cohort of 138 patients with confirmed EGFR status and pre-treatment CT scans was analyzed. Radiomic features were extracted with PyRadiomics, and feature selection applied mutual information, Spearman correlation, and wrapper-based methods. Five Random Forest models were trained with different feature sets. The best-performing model, based on 11 selected variables, achieved an AUC of 0.91 (95% CI: 0.81–1.00) under stratified five-fold cross-validation, with an accuracy of 0.88 ± 0.03. Subgroup analysis showed that EGFR-WT had a performance of precision 0.93 ± 0.04, recall 0.92 ± 0.03, F1-score 0.91 ± 0.02, and EGFR-Mutant had a performance of precision 0.76 ± 0.05, recall 0.71 ± 0.05, F1-score 0.68 ± 0.04. SHapley Additive exPlanations (SHAP) analysis identified tobacco use, enhancement pattern, and gray-level-zone entropy as key predictors. Decision curve analysis confirmed clinical utility, supporting its role as a non-invasive tool for EGFR-screening. Full article

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24 pages, 2998 KB

Open AccessReview

Safety and Tolerability of Inhaled Aztreonam in Children and Adolescents: A Systematic Review and Meta-Analysis

by Valmir N. Rastely-Junior, Hosanea S. N. Rocha and Mitermayer G. Reis

Adv. Respir. Med. 2025, 93(5), 38; https://doi.org/10.3390/arm93050038 - 26 Sep 2025

Viewed by 937

Abstract

Respiratory infections and chronic lung disease are major contributors to morbidity in children. Aztreonam lysine for inhalation (AZLI) delivers high local antibiotic concentrations while limiting systemic exposure; however, its safety in younger patients remains uncertain. This systematic review and meta-analysis searched MEDLINE, CENTRAL, [...] Read more.

Respiratory infections and chronic lung disease are major contributors to morbidity in children. Aztreonam lysine for inhalation (AZLI) delivers high local antibiotic concentrations while limiting systemic exposure; however, its safety in younger patients remains uncertain. This systematic review and meta-analysis searched MEDLINE, CENTRAL, and Google Scholar for randomized and observational studies reporting adverse events in children and adolescents (≤18 years) receiving AZLI, with no date limit. Fourteen studies were included. Most studies were moderate-to-high quality. Comparative analysis showed no clinically relevant increase in common adverse events relative to placebo or other inhaled antibiotics. The pooled relative risk for severe respiratory disorders (grade 3/4) was 1.65 (95% CI 1.07–2.57), suggesting a higher incidence of serious respiratory events, while a protective effect against decline in pulmonary function was observed (RR 0.70, 95% CI 0.54–0.90). Adverse events were generally mild; serious adverse events and hospitalizations were infrequent and comparable between groups. Cumulative prevalence estimates indicated that respiratory irritation occurred in 10–25% of patients, whereas systemic effects were uncommon. Overall, AZLI appears to have an acceptable tolerability and safety profile in children and adolescents, though careful monitoring is warranted, especially for severe respiratory events. Full article

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17 pages, 724 KB

Open AccessArticle

FeNO 350 mL/s: Unlocking the Small Airways to Achieve Clinical Remission in Severe Asthma—A Pilot Study

by Vitaliano Nicola Quaranta, Andrea Portacci, Leonardo Maselli, Marta Tornesello, Maria Granito, Gennaro Rociola, Silvano Dragonieri and Giovanna Elisiana Carpagnano

Adv. Respir. Med. 2025, 93(5), 37; https://doi.org/10.3390/arm93050037 - 17 Sep 2025

Viewed by 1217

Abstract

Background: Several studies focused on the importance of managing small airways disease in the treatment of severe asthma, whose improvement can improve respiratory symptoms, lung function, and airways inflammation, potentially reaching the objective of clinical remission. Methods: Twenty-five patients with severe asthma and [...] Read more.

Background: Several studies focused on the importance of managing small airways disease in the treatment of severe asthma, whose improvement can improve respiratory symptoms, lung function, and airways inflammation, potentially reaching the objective of clinical remission. Methods: Twenty-five patients with severe asthma and without bronchiectasis were enrolled. They were started on biological therapies with Omalizumab, Dupilumab, Benralizumab or Mepolizumab. Follow-up evaluations were conducted at baseline (T0) and after one year of biological therapy (T1). Assessments included clinical evaluations, spirometry, questionnaires, and inflammatory markers. Results: Predictive analysis identified baseline FeNO 350 mL/s levels as a significant predictor of clinical remission in both univariable and multivariable analysis. Higher FeNO 350 mL/s levels at T0 were associated with an increased likelihood of achieving remission (p = 0.012). The optimal cutoff value for FeNO 350 mL/s was determined to be 18 ppb, based on the Younden Index. Conclusions: Following patients with severe asthma on biological therapy for one year, FeNO 350 mL/s could be used as a predictive factor of clinical remission, highlighting its importance as inflammatory marker not only in small airways disease, but also in predicting clinical remission in severe asthmatic patients. Full article

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7 pages, 348 KB

Open AccessBrief Report

Detecting Airway Involvement in Non-Asthmatic Eosinophilic Disorders: Diagnostic Utility of Fractional Exhaled Nitric Oxide (FeNO)

by Nicolas Raoul, Lucie Laurent, Ophélie Ritter, Pauline Roux-Claudé, Faraj Al Freijat, Nadine Magy-Bertrand, Virginie Westeel and Cindy Barnig

Adv. Respir. Med. 2025, 93(5), 36; https://doi.org/10.3390/arm93050036 - 16 Sep 2025

Viewed by 999

Abstract

Airway involvement in eosinophilic disorders other than asthma is not well-defined, and the symptoms may be overshadowed by other more prominent eosinophilic extra-respiratory manifestations. This study aimed to evaluate the utility of fractional exhaled nitric oxide (FeNO) in diagnosing eosinophilic airway involvement in [...] Read more.

Airway involvement in eosinophilic disorders other than asthma is not well-defined, and the symptoms may be overshadowed by other more prominent eosinophilic extra-respiratory manifestations. This study aimed to evaluate the utility of fractional exhaled nitric oxide (FeNO) in diagnosing eosinophilic airway involvement in patients with persistent eosinophilia (>0.5 × 10⁹/L). We conducted a retrospective analysis of adult patients with confirmed peripheral blood eosinophilia (>0.5 × 10⁹/L) on at least two occasions one month apart. Patients with blood eosinophilia associated with known eosinophilic airway inflammatory diseases were excluded from the study. Pulmonary function testing, spirometry, and FeNO measurement were conducted. A total of 14 patients with various eosinophil-related disorders were identified, with a mean age of 65.7 years. Increased FeNO levels were associated with airflow obstruction and clinical symptoms such as coughing and wheezing. Notably, eosinophil levels were not predictive of eosinophilic airway involvement. FeNO could be a useful diagnostic tool for detecting bronchial eosinophilic airway inflammation in non-asthmatic disorders, thereby enabling appropriate treatment. Further studies with larger cohorts are needed to validate these findings. Full article

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33 pages, 1193 KB

Open AccessReview

Bronchial Artery Embolisation in Haemoptysis Management: A Scoping Review with Emphasis on Embolic Materials and Indications

by Anna Ziętarska, Adam Dobek, Anna Sawina, Piotr Białek, Sebastian Majewski and Ludomir Stefańczyk

Adv. Respir. Med. 2025, 93(5), 35; https://doi.org/10.3390/arm93050035 - 12 Sep 2025

Viewed by 2684

Abstract

Haemoptysis is an alarming symptom of a wide spectrum of underlying diseases, ranging from indolent chronic conditions to life-threatening states. Among the strategies to manage pulmonary bleeding is bronchial artery embolisation (BAE), an interventional radiology procedure. The objective of this scoping review was [...] Read more.

Haemoptysis is an alarming symptom of a wide spectrum of underlying diseases, ranging from indolent chronic conditions to life-threatening states. Among the strategies to manage pulmonary bleeding is bronchial artery embolisation (BAE), an interventional radiology procedure. The objective of this scoping review was to map the current evidence on embolic agents used in BAE for haemoptysis management, with a focus on their clinical applications, and decision-making factors. Studies published between 2019 and 2024 were included if they specified the embolic material used and reported outcomes of BAE in adult patients. Data were extracted from PubMed and charted according to embolic agent type, recurrence rate, and clinical context. Thirty-one studies met the eligibility criteria. Polyvinyl alcohol (PVA) remains the most widely studied agent, comparable in efficacy to more homogeneous microspheres. Gelatin sponges (GS), though biodegradable, are well-documented and affordable, making them a common choice. N-butyl-2-cyanoacrylate (NBCA) is highly effective for small vessels and may offer lower recurrence rates. Coils are valuable in proximal embolisation and severe cases. This review highlights the need for individualised embolisation strategies and updated guidelines for material selection, considering clinical context, vascular anatomy, and recurrence rates. The findings aim to support evidence-based decision-making in interventional radiology practice. Full article

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22 pages, 3915 KB

Open AccessArticle

The Safety and Performance of a Novel Extracorporeal Membrane Oxygenation Device in a Long-Term Ovine Model

by Yongchao Li, Lei Cai, Jia Huang, Hongbin Gao, Zhongqiang Huang, Yalun Guan, Yunfeng Li, Shuhua Liu, Shi Liang, Summer Xiatian Li, Hongzhou Lu, Ge Li, Yijiang Li and Yu Zhang

Adv. Respir. Med. 2025, 93(5), 34; https://doi.org/10.3390/arm93050034 - 9 Sep 2025

Viewed by 1470

Abstract

Since extracorporeal membrane oxygenation (ECMO) is primarily used for patients in a high-risk state and is an invasive procedure, its unique application scenarios make it difficult to recruit suitable cases for clinical trials. Therefore, large animal models have become one of the most [...] Read more.

Since extracorporeal membrane oxygenation (ECMO) is primarily used for patients in a high-risk state and is an invasive procedure, its unique application scenarios make it difficult to recruit suitable cases for clinical trials. Therefore, large animal models have become one of the most important models for preclinical evaluation of the safety and effectiveness of ECMO. This study aims to assess the safety and performance of a novel portable ECMO device with Small-tail Han sheep. Fifteen sheep were divided into a test group (LIFEMOTION, Chinabridge, Shenzhen, China) and control group (NOVALUNG XLUNG kit 230, Xonis, Heilbronn, Germany) with veno-venous ECMO (VV-ECMO) and veno-arterial ECMO (VA-ECMO) modes. Tracheal intubation, arteriovenous access, and ECMO support were performed. Vital signs and blood laboratory tests of the subjects were monitored and recorded. The main organs were examined pathologically at the end of day fourteen. The serum protein expression profile was analyzed by protein quantification techniques. All sheep were successfully weaned from ECMO without transfusion or cannula complications. No significant differences were observed between the two groups in terms of vital signs, oxygenation, hemodynamic stability, and physiological function (p > 0.05). According to the serum protein expression profile, no significant biomarkers associated with ECMO clinical complications were identified. The LIFEMOTION ECMO device demonstrated good safety and efficacy. Full article

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10 pages, 585 KB

Open AccessArticle

Test–Retest Reliability and Minimal Detectable Change of the 6-Minute Step Test and 1-Minute Sit-to-Stand Test in Post-COVID-19 Patients

by Patchareeya Amput, Weerasak Tapanya, Sirima Wongphon, Krittin Naravejsakul and Thanakorn Sritiyot

Adv. Respir. Med. 2025, 93(5), 33; https://doi.org/10.3390/arm93050033 - 8 Sep 2025

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Abstract

Background: This study aims to determine test–retest reliability and to calculate minimal detectable change (MDC) scores for the functional capacity of the 6-minute step test (6MST) and 1 min sit-to-stand test (1-min-STST), and compare these outcomes with the 6-minute walk test (6MWT) in [...] Read more.

Background: This study aims to determine test–retest reliability and to calculate minimal detectable change (MDC) scores for the functional capacity of the 6-minute step test (6MST) and 1 min sit-to-stand test (1-min-STST), and compare these outcomes with the 6-minute walk test (6MWT) in post-COVID-19 patients. Methods: A total of 42 post-COVID-19 patients aged 18 years or older were recruited for this study. The post-COVID-19 patients were investigated for cardiovascular response parameters induced by a 6MWT, 6MST, and 1-min-STST on two different days, with a five-day interval between the first and second days. Results: The test–retest reliability obtained between the initial measurement and the measurement recorded five days later in the post-COVID-19 patients was excellent for all three of the 6MWT, 6MST, and 1-min-STST. The ICC of the 6MWT was 0.97 with MDC95 at 5.57%. The ICC of the 6MST was 0.93 with MDC95 at 12.21%, while, the ICC of the 1-min-STST was 0.96 with MDC95 at 3.61%. Conclusions: The 6MST and 1-min-STST were valid and acceptable for the evaluation of functional capacity in post- COVID-19 patients and can be used to investigate whether each post-COVID-19 patient had made significant improvement in a clinical setting. Full article

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Open AccessArticle

Machine Learning-Driven Lung Sound Analysis: Novel Methodology for Asthma Diagnosis

by Ihsan Topaloglu, Gulfem Ozduygu, Cagri Atasoy, Guntug Batıhan, Damla Serce, Gulsah Inanc, Mutlu Onur Güçsav, Arif Metehan Yıldız, Turker Tuncer, Sengul Dogan and Prabal Datta Barua

Adv. Respir. Med. 2025, 93(5), 32; https://doi.org/10.3390/arm93050032 - 4 Sep 2025

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Abstract

Introduction: Asthma is a chronic airway inflammatory disease characterized by variable airflow limitation and intermittent symptoms. In well-controlled asthma, auscultation and spirometry often appear normal, making diagnosis challenging. Moreover, bronchial provocation tests carry a risk of inducing acute bronchoconstriction. This study aimed to [...] Read more.

Introduction: Asthma is a chronic airway inflammatory disease characterized by variable airflow limitation and intermittent symptoms. In well-controlled asthma, auscultation and spirometry often appear normal, making diagnosis challenging. Moreover, bronchial provocation tests carry a risk of inducing acute bronchoconstriction. This study aimed to develop a non-invasive, objective, and reproducible diagnostic method using machine learning-based lung sound analysis for the early detection of asthma, even during stable periods. Methods: We designed a machine learning algorithm to classify controlled asthma patients and healthy individuals using respiratory sounds recorded with a digital stethoscope. We enrolled 120 participants (60 asthmatic, 60 healthy). Controlled asthma was defined according to Global Initiative for Asthma (GINA) criteria and was supported by normal spirometry, no pathological auscultation findings, and no exacerbations in the past three months. A total of 3600 respiratory sound segments (each 3 s long) were obtained by dividing 90 s recordings from 120 participants (60 asthmatic, 60 healthy) into non-overlapping clips. The samples were analyzed using Mel-Frequency Cepstral Coefficients (MFCCs) and Tunable Q-Factor Wavelet Transform (TQWT). Significant features selected with ReliefF were used to train Quadratic Support Vector Machine (SVM) and Narrow Neural Network (NNN) models. Results: In 120 participants, pulmonary function test (PFT) results in the asthma group showed lower FEV1 (86.9 ± 5.7%) and FEV1/FVC ratios (86.1 ± 8.8%) compared to controls, but remained within normal ranges. Quadratic SVM achieved 99.86% accuracy, correctly classifying 99.44% of controls and 99.89% of asthma cases. Narrow Neural Network achieved 99.63% accuracy. Sensitivity, specificity, and F1-scores exceeded 99%. Conclusion: This machine learning-based algorithm provides accurate asthma diagnosis, even in patients with normal spirometry and clinical findings, offering a non-invasive and efficient diagnostic tool. Full article

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Adv. Respir. Med., Volume 93, Issue 5 (October 2025) – 16 articles

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