Advances in Respiratory Medicine

2 pages, 154 KiB

Open AccessComment

Comment on Giraldo-Ocampo et al. B Cell Subsets in Colombian Adults with Predominantly Antibody Deficiencies, Bronchiectasis or Recurrent Pneumonia. Adv. Respir. Med. 2022, 90, 254–266

by Behnam Shafaei

Adv. Respir. Med. 2025, 93(3), 15; https://doi.org/10.3390/arm93030015 - 9 Jun 2025

Abstract

I am writing regarding the article titled “B Cell Subsets in Colombian Adults with Predominantly Antibody Deficiencies, Bronchiectasis or Recurrent Pneumonia” [...] Full article

13 pages, 250 KiB

Open AccessArticle

Environmental Factors Affecting Sleep Quality in Intensive Care Unit Patients in Southern Morocco: An Assessment Study

by Abdelmajid Lkoul, Keltouma Oumbarek, Youssef Bouchriti, Asmaa Jniene and Tarek Dendane

Adv. Respir. Med. 2025, 93(3), 14; https://doi.org/10.3390/arm93030014 - 6 Jun 2025

Abstract

Introduction: Sleep disturbances are a common and often underestimated complication during intensive care unit (ICU) stays. These disturbances can significantly impact patients’ recovery and overall well-being. This study aimed to assess the sleep quality of ICU patients and investigate the environmental and clinical [...] Read more.

Introduction: Sleep disturbances are a common and often underestimated complication during intensive care unit (ICU) stays. These disturbances can significantly impact patients’ recovery and overall well-being. This study aimed to assess the sleep quality of ICU patients and investigate the environmental and clinical factors that affect sleep quality during their ICU stay. Methods: We conducted a six-month cross-sectional study involving patients who had stayed in the ICU for at least three nights and were oriented to time and place upon discharge. Sleep quality was assessed using the Arabic version of the Freedman Sleep Questionnaire. Both environmental factors (e.g., noise, light, and nursing interventions) and clinical variables (illness severity and pain) were examined. The differences across three time periods were analyzed using the Wilcoxon test and Spearman’s correlation. Multiple regression analysis identified the factors influencing sleep quality. Statistical analyses were performed using JAMOVI software (version 2.3.28). Results: The study enrolled 328 patients, with an average age of 49.74 ± 17.89 years. Of the participants, 75.3% were adults. The primary reasons for admission were circulatory distress (45.73%) and metabolic disorders (24.09%). Sleep quality was significantly lower in the ICU compared to patients’ sleep at home (Z = −14.870, p < 0.001). The EVA and APACHE II scores had a statistically significant effect on sleep quality (p < 0.001 and p = 0.015, respectively). In contrast, the Charlson and Quick SOFA scores did not show significant effects (p = 0.128 and p = 0.894). Environmental factors, including noise (p = 0.008), light (p = 0.009), and nursing interventions (p = 0.009), significantly impacted sleep quality. Conclusions: Patients in the ICU generally reported poor sleep quality. Our findings suggest that improving pain management, minimizing environmental noise, and reducing staff-related disturbances could significantly enhance sleep quality for patients in the intensive care unit (ICU). Full article

14 pages, 1072 KiB

Open AccessReview

Efficacy and Safety of P. hybridus Leaf Extract Ze 339 for the Treatment of Allergic Rhinitis

by Verena M. Merk, Georg Boonen, Veronika Butterweck and Andreas Schapowal

Adv. Respir. Med. 2025, 93(3), 13; https://doi.org/10.3390/arm93030013 - 3 Jun 2025

Abstract

Allergic rhinitis (AR) is a global health problem on the rise. More and more people are affected, and climate change is exacerbating this health problem in the long term. The quality of life of those affected is often severely compromised, and the financial [...] Read more.

Allergic rhinitis (AR) is a global health problem on the rise. More and more people are affected, and climate change is exacerbating this health problem in the long term. The quality of life of those affected is often severely compromised, and the financial burden on healthcare systems cannot be disregarded. Therefore, effective and safe medicines are needed to counteract this trend. P. hybridus (butterbur) leaf extract (Ze 339) displays a promising alternative to antihistamines in the treatment of AR symptoms. More than two decades after the first market launch it is now possible to draw a meaningful conclusion on its safety and efficacy. This review summarizes the available preclinical and clinical data, real-world data (RWD) as well as data from post-marketing pharmacovigilance monitoring about the herbal medicinal drug Ze 339. It focusses on the current knowledge about the mode of action as well as the evaluation of its efficacy and safety in the treatment of AR. Given its favourable safety profile and lack of sedative side effects, Ze 339 offers a valuable alternative to antihistamines and should therefore continue to be considered by medical practitioners for the treatment of allergic rhinitis symptoms. Full article

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11 pages, 804 KiB

Open AccessArticle

High Prevalence of Depression and Anxiety in Patients with Chronic Respiratory Diseases Admitted to Intensive Care in a Low-Resource Setting

by Amun Mustafa, Asifa Karamat, Wajeeha Mustansar Toor and Tehmina Mustafa

Adv. Respir. Med. 2025, 93(3), 12; https://doi.org/10.3390/arm93030012 - 2 Jun 2025

Abstract

Background: Depression and anxiety are common in patients with chronic respiratory diseases (CRDs), but their prevalence in intensive care settings, particularly in low-resource regions, remains underexplored. Objective: To assess the prevalence and severity of depression and anxiety in patients with CRDs admitted to [...] Read more.

Background: Depression and anxiety are common in patients with chronic respiratory diseases (CRDs), but their prevalence in intensive care settings, particularly in low-resource regions, remains underexplored. Objective: To assess the prevalence and severity of depression and anxiety in patients with CRDs admitted to an intensive care unit (ICU) and identify associated factors. Methods: A cross-sectional study was conducted at Gulab Devi Teaching Hospital, Lahore, Pakistan. Adult patients with CRDs admitted to the ICU were assessed using the Hamilton Depression Rating Scale. Statistical analyses included Fisher’s exact test, Mann–Whitney/Kruskal–Wallis tests, and logistic regression. Results: Depression was highly prevalent across all CRD categories: 83%, 89%, 84%, and 93% in obstructive, restrictive, infectious, and other respiratory disease categories, and severe depression in 16%, 18%, 14%, and 37%, respectively. Anxiety symptoms were also widespread (77–100%), with no significant differences across disease groups. Depression was significantly associated with older age (p < 0.001, OR 1.08) and anxiety symptoms (p < 0.001, OR 47.07). Female gender was linked to anxiety (p = 0.034, OR 4.17). Conclusion: The high burden of depression and anxiety in ICU patients with CRDs underscores the need for routine psychiatric screening and integrated mental health care in critical-care settings. Full article

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14 pages, 482 KiB

Open AccessArticle

Malnutrition, Sarcopenia, and Malnutrition Sarcopenia Syndrome in Idiopathic Pulmonary Fibrosis

by Eva Cabrera-César, Rocío Fernández-Jiménez, Javier Lopez-Garcia, Alicia Sanmartín-Sánchez, Miguel Benítez Cano-Gamonoso, Isabel Asschert Agüero, Francisco Espíldora-Hernández, Luis Fernandez de Rota Garcia, Isabel Vega-Aguilar, Maria del Mar Amaya-Campos, Francisco J. Tinahones, Jose Manuel Garcia-Almeida and Jose Luis Velasco-Garrido

Adv. Respir. Med. 2025, 93(3), 11; https://doi.org/10.3390/arm93030011 - 29 May 2025

Abstract

Introduction: Idiopathic pulmonaryy fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. While comorbidities like pulmonary hypertension and lung cancer have been studied extensively, less attention has been paid to the implications of malnutrition and sarcopenia in patients with IPF. [...] Read more.

Introduction: Idiopathic pulmonaryy fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. While comorbidities like pulmonary hypertension and lung cancer have been studied extensively, less attention has been paid to the implications of malnutrition and sarcopenia in patients with IPF. This study aimed to assess the prevalence of malnutrition, sarcopenia, and the combined malnutrition-sarcopenia syndrome in patients with IPF using the latest diagnostic criteria from the Global Leadership Initiative on Malnutrition (GLIM) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Methods: A prospective, observational, multicenter study was conducted, focusing on patients with idiopathic pulmonary fibrosis (IPF). All participants provided informed consent, and the study followed ethical guidelines. Malnutrition was diagnosed based on the GLIM criteria, requiring one phenotypic and one etiological criterion, with muscle mass assessed via bioelectrical impedance analysis (BIA). Sarcopenia was screened following the EWGSOP2 recommendations. The statistical analysis was performed using JAMOVI version 2.3.22, with significance set at p < 0.05. Results: The findings revealed that 77.65% of the participants were malnourished, and 20% had sarcopenia. The malnourished patients had significantly lower body weight, height, and muscle mass compared to the non-malnourished patients. Furthermore, the patients with malnutrition exhibited poorer health-related quality of life scores. This study also identified the malnutrition-sarcopenia syndrome in 8.23% of the participants. Conclusions: Malnutrition, based on the GLIM criteria was identified in three out of four patients with IPF, while sarcopenia according to the EWGSOP2 was present in one out of five. This study underscores the necessity for routine screening for malnutrition and sarcopenia in patients with IPF. Full article

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10 pages, 578 KiB

Open AccessArticle

Inspiratory Muscle Training Improved Cardiorespiratory Performance in Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial

by Chitima Kulchanarat, Suphannee Choeirod, Supattra Thadatheerapat, Dusarkorn Piathip, Opas Satdhabudha and Kornanong Yuenyongchaiwat

Adv. Respir. Med. 2025, 93(3), 10; https://doi.org/10.3390/arm93030010 - 27 May 2025

Abstract

Aim: This study aimed to evaluate the effects of inspiratory muscle training on inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery. Method: This study was conducted as a randomized controlled trial with two groups. Fifty-eight patients who underwent open [...] Read more.

Aim: This study aimed to evaluate the effects of inspiratory muscle training on inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery. Method: This study was conducted as a randomized controlled trial with two groups. Fifty-eight patients who underwent open heart surgery were randomly assigned to either the intervention group or the control group 29 in the control group and 29 in the intervention group. Patients in the intervention group participated in a physical therapy program combined with inspiratory muscle training using the Thammasat University (TU) Breath Trainer. Patients in the control group received only the standard physical therapy program. The maximum inspiratory pressure, maximum expiratory pressure and 6 min walk test distance were assessed both before surgery and prior to hospital discharge. Results: The intervention group had a significant increase in maximum inspiratory pressure (p < 0.001), maximum expiratory pressure (p < 0.001) and 6 min walk test distance (p = 0.013). The control group had a significant decrease in maximum inspiratory pressure (p < 0.001), maximum expiratory pressure (p = 0.002) and 6 min walk test distance (p < 0.001). Conclusions: Inspiratory muscle training can be performed using maximum pressure resistors, such as the TU-Breath Trainer device. This training has been shown to effectively improve inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery, as well as reduce pulmonary complications and shorten the length of hospital stay. Full article

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10 pages, 1366 KiB

Open AccessArticle

Changes in Lung Ultrasound in Systemic Sclerosis Before and After Rehabilitation: A Comparative Study Between People with and Without Interstitial Lung Disease

by Samantha Gomes de Alegria, Matheus Mello da Silva, Jéssica Gabriela Messias Oliveira, Beatriz Luiza Pinheiro Alves de Azevedo, Nathália Alves de Oliveira Saraiva, Isabelle da Nóbrega Ferreira, Joana Acar Silva, Thiago Thomaz Mafort, Cláudia Henrique da Costa and Agnaldo José Lopes

Adv. Respir. Med. 2025, 93(3), 9; https://doi.org/10.3390/arm93030009 - 20 May 2025

Abstract

There is limited research on the impact of a physiotherapy-guided rehabilitation program (PGRP) on lung structure in systemic sclerosis (SSc). Lung ultrasound (LUS) has been used for over a decade to identify interstitial lung disease associated with SSc (SSc-ILD). This study aims to [...] Read more.

There is limited research on the impact of a physiotherapy-guided rehabilitation program (PGRP) on lung structure in systemic sclerosis (SSc). Lung ultrasound (LUS) has been used for over a decade to identify interstitial lung disease associated with SSc (SSc-ILD). This study aims to evaluate the impact of a PGRP on LUS signals in women with SSc-ILD and women without ILD (SSc-wILD). This is a longitudinal quasi-experimental study that included 33 women with SSc. The results show that changes in LUS were observed in 22 participants, especially B-lines > two. Before the PGRP the median of B-lines > two was three (0–7), while after the PGRP it was three (0–6) (p = 0.020). The aeration score was eight (0–16.5) pre-PGRP and three (0–16) post-PGRP (p = 0.013). Analyzing the impact of the PGRP on LUS signals in SSc-ILD and SSc-wILD groups, the main change observed was a reduction in B-lines > two between pre-PGRP and post-PGRP in the SSc-ILD group (p = 0.0004). The SSc-ILD group had a higher aeration score than the SSc-wILD group both pre-PGRP (p < 0.0001) and post-PGRP (p = 0.0001)]. In conclusion, LUS may be a complementary tool for assessing pre- and post-PGRP changes in people with SSc-ILD and SSc-wILD. Our data also suggest that the PGRP can elicit measurable changes in LUS findings in SSc, particularly in SSc-ILD. These findings support the inclusion of LUS in the routine monitoring of SSc and the use of a PGRP as a non-pharmacologic adjunctive strategy in SSc. Full article

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14 pages, 744 KiB

Open AccessReview

Mobile Phone-Mediated Interventions to Improve Adherence to Prescribed Treatment in Chronic Obstructive Pulmonary Disease: A Systematic Review

by Andrea Paleo, Catalina Carretta, Francisca Pinto, Estefanno Saltori, Joaquín González Aroca and Álvaro Puelles

Adv. Respir. Med. 2025, 93(2), 8; https://doi.org/10.3390/arm93020008 - 18 Apr 2025

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder that poses significant challenges in treatment adherence. This systematic review evaluates the effectiveness of mobile health (mHealth) interventions compared to conventional therapy in improving treatment adherence among COPD patients. A total of 13 [...] Read more.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder that poses significant challenges in treatment adherence. This systematic review evaluates the effectiveness of mobile health (mHealth) interventions compared to conventional therapy in improving treatment adherence among COPD patients. A total of 13 randomized controlled trials and comparative cohort studies published up to July 2023 were included, analyzing interventions such as medication reminders and remote monitoring in adult COPD patients. Studies involving participants under 18 years of age or with severe comorbidities were excluded. This review identified 4688 records from MEDLINE, WEB OF SCIENCE, and SCOPUS. Of these, 13 studies met the inclusion criteria. The selection process was conducted by two independent reviewers, with discrepancies resolved by consensus with a third reviewer. The results showed that mHealth interventions improved treatment adherence in some studies, particularly in exercise and symptom monitoring; however, the evidence was inconsistent, and results varied across studies. This review concludes that mHealth interventions have the potential to improve adherence but higher-quality studies and more robust designs are needed to confirm these findings and support their clinical implementation. Full article

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9 pages, 6058 KiB

Open AccessArticle

Heterozygous Men1(+/T) Knockout Mice Do Not Develop Bronchopulmonary Neuroendocrine Hyperplasia or Neoplasia but Bronchial Adenocarcinoma

by Max B. Albers, Ludger Fink, Jerena Manoharan, Caroline L. Lopez, Carmen Bollmann and Detlef K. Bartsch

Adv. Respir. Med. 2025, 93(2), 7; https://doi.org/10.3390/arm93020007 - 31 Mar 2025

Abstract

Introduction: Bronchopulmonary Neuroendocrine Neoplasms (NEN) occur in 2–7% of patients with multiple endocrine neoplasia type 1 (MEN1). Precursor lesions have been identified for MEN1-related pancreatic, duodenal, and gastric NEN. The aim of the current study using a MEN1 mouse model was to define [...] Read more.

Introduction: Bronchopulmonary Neuroendocrine Neoplasms (NEN) occur in 2–7% of patients with multiple endocrine neoplasia type 1 (MEN1). Precursor lesions have been identified for MEN1-related pancreatic, duodenal, and gastric NEN. The aim of the current study using a MEN1 mouse model was to define the precursor lesions of bronchopulmonary NEN and evaluate the potential prophylactic antitumor effects of somatostatin analogues in a transgenic MEN1 mouse model. Methods: Fifteen mice, germline heterozygous for Men1(+/T), were treated with subcutaneous injections of lanreotide autogel (Somatuline Autogel^®, IPSEN Pharma), while 15 mice were treated with subcutaneous injections of physiologic sodium chloride as the control group. Five mice from each group were euthanized after 12, 15, and 18 months, respectively. The complete lungs were resected and evaluated after hematoxylin and eosin staining and immunohistochemistry for synaptophysin and chromogranin A. Results: In the lungs of the 30 evaluated mice, whether treated or placebo treated, no bronchopulmonary neuroendocrine cell hyperplasia nor neuroendocrine neoplasia was detected through histopathology. However, pulmonary adenocarcinoma developed in 2 (13%) of the 15 untreated mice and in 1 (7%) of the 15 lanreotide-treated mice. Conclusions: Heterozygous Men1(+/T) knockout mice do not develop bronchopulmonary NEN or precursor lesions, but pulmonary adenocarcinoma. This surprising result needs to be investigated in more detail. Full article

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10 pages, 2111 KiB

Open AccessArticle

The Impact of Corticosteroids on Mortality in Acute Exacerbations of Idiopathic Pulmonary Fibrosis: A Meta-Analysis

by Pier-Valerio Mari, Angelo Coppola, Lorenzo Carriera and Francesco Macagno

Adv. Respir. Med. 2025, 93(2), 6; https://doi.org/10.3390/arm93020006 - 28 Mar 2025

Abstract

Background: Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is one of the most challenging events in the disease course due to the high mortality despite treatment. The role of corticosteroid treatment in AE-IPF has never been defined, even though it is [...] Read more.

Background: Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is one of the most challenging events in the disease course due to the high mortality despite treatment. The role of corticosteroid treatment in AE-IPF has never been defined, even though it is used in current clinical practice. We performed a meta-analysis to determine the effects of steroid treatment on the acute exacerbation outcomes in idiopathic pulmonary fibrosis (IPF). Objectives: To evaluate the impact of steroids on mortality in patients affected by an acute exacerbation of IPF. Methods: This meta-analysis was performed in accordance with the PRISMA statement. A systemic literature search was conducted through Google Scholar, Scopus, WoS, PubMed, and JSTOR. Manuscripts from January 2014 to September 2024 were included in the analysis. Articles were included on whether participants had an acute exacerbation of IPF. Regarding the intervention performed, we evaluated the studies in which patients underwent treatment with corticosteroids. As outcomes, studies were included if they analyzed the overall mortality. Results: A total of 2156 records were initially identified. Nineteen studies (3277 patients) were ultimately included in the final analysis, comparing 1552 patients who received steroids to 1725 patients without steroids. Steroid treatment poses a higher risk, as suggested by the summary measures (RR of 1.78; CI 1.29–2.76, p = 0.00001). Conclusions: This meta-analysis investigated the debated role of corticosteroid treatment during acute exacerbation of idiopathic pulmonary fibrosis. Overall, steroid therapy is associated with increased risk. Clinicians should carefully weigh the risks and benefits of corticosteroid therapy in acute exacerbation of IPF. Full article

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14 pages, 1038 KiB

Open AccessArticle

Are There Differences in Postural Control and Muscular Activity in Individuals with COPD and with and Without Sarcopenia?

by Walter Sepúlveda-Loyola, Alejandro Álvarez-Bustos, Juan José Valenzuela-Fuenzalida, Carla María Ordinola Ramírez, Carol Saldías Solis and Vanessa Suziane Probst

Adv. Respir. Med. 2025, 93(1), 5; https://doi.org/10.3390/arm93010005 - 18 Feb 2025

Abstract

Aim: The aim of this study was to compare balance performance and electromyographic activity in individuals with COPD, with and without sarcopenia. Method: Thirty-five patients with COPD were classified with and without sarcopenia according to EWGSOP criteria. Balance was assessed using a force [...] Read more.

Aim: The aim of this study was to compare balance performance and electromyographic activity in individuals with COPD, with and without sarcopenia. Method: Thirty-five patients with COPD were classified with and without sarcopenia according to EWGSOP criteria. Balance was assessed using a force platform under four conditions: standing with feet apart and eyes opened (FHEO), eyes closed (FHEC), on an unstable surface (US), and on one leg (OLS). The surface electromyography activity of lower limb muscles and trunks was recorded. Additionally, the timed up and go test (TUG) and the Brief Balance Evaluation Systems Test (Brief-BESTest) were also utilized. Results: Under the FHEO, FHEC, and US conditions, individuals with sarcopenia demonstrated increased velocities, larger oscillation amplitudes, and greater center of pressure displacements under the US condition (p ≤ 0.02). They also showed a higher activation of the scalene, sternocleidomastoid, and abdominal muscles during OLS, along with a reduced activation of the tibialis anterior during OLS and US, and a decreased activation of the vastus medialis during FHEC and US (p ≤ 0.04). Furthermore, sarcopenic COPD patients exhibited poorer performance on the TUG and Brief-BESTest compared to their non-sarcopenic counterparts (p ≤ 0.02). Conclusions: Individuals with COPD and sarcopenia demonstrated greater instability in both bipedal stances and on unstable surfaces, as well as poorer performance in both dynamic and static balance assessments. Furthermore, these individuals exhibited reduced muscular activation in the lower limbs compared to those without sarcopenia. Full article

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22 pages, 4246 KiB

Open AccessReview

A Meta-Analysis of the Impact of Using Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II Receptor Blockers (ARBs) on Mortality, Severity, and Healthcare Resource Utilization in Patients with COVID-19

by Ruijuan Li, Jie Zhang and Liang Ren

Adv. Respir. Med. 2025, 93(1), 4; https://doi.org/10.3390/arm93010004 - 18 Feb 2025

Abstract

Objective: The primary objective of this study is to explore the potential link between the utilization of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and its impact on mortality, disease severity, and healthcare resource utilization in individuals diagnosed with COVID-19. [...] Read more.

Objective: The primary objective of this study is to explore the potential link between the utilization of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and its impact on mortality, disease severity, and healthcare resource utilization in individuals diagnosed with COVID-19. We aim to establish a solid theoretical foundation for safe and effective clinical medications. Methods: We conducted a comprehensive search of various databases, including CNKI, PubMed, Science, Cell, Springer, Nature, Web of Science, and Embase. We also traced the literature of the included studies to ensure a thorough analysis of the available evidence. After applying a set of inclusion and exclusion criteria, we ultimately included a total of 41 articles in our analysis. To determine the overall effect size for dichotomous variables, we used the Mantel–Haenszel odds ratio in random effect models. For continuous variables, we calculated the inverse variance SMD using random effect models. To assess the outcomes and heterogeneity, we considered p-values (p < 0.05) and I² values for all outcomes. We performed multivariate and univariate meta-regression analyses using the maximum likelihood approach with the CMA 3.0 software. Results: The results of our analysis indicated that the use of ACEIs or ARBs did not significantly influence mortality (OR = 1.10, 95% CI 0.83–1.46, p = 0.43, I² = 84%), severity (OR = 0.99, 95% CI 0.68–1.45, p = 0.98, I² = 84%), or healthcare resource utilization (SMD = 0.03, 95% CI 0.06–0.12, p = 0.54, I² = 37%) in patients with COVID-19 compared to those not taking ACEIs or ARBs. The multivariate meta-regression analysis model explained 63%, 31%, and 100% of the sources of heterogeneity for the three outcome indicators. Conclusions: The use of ACEIs and ARBs is not significantly correlated with mortality, severity, or healthcare resource utilization in patients with COVID-19, indicating safe clinical use of the medications. Full article

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11 pages, 2419 KiB

Open AccessArticle

Prospective, Open-Label, Observational, Multicenter, Single Arm, Post-Marketing Study in Asthmatic Patients for Evaluation of Safety and Effectiveness of Indacaterol/Mometasone DPI (PROMISING-SHIFT)

by Saurabh Karmakar, Gajendra V. Singh, Amit S. Bhate, Vijaykumar Barge, Bharat Mehrotra, Chintan Patel, Ekta Sinha, Sagar Bhagat, Saiprasad Patil and Hanmant Barkate

Adv. Respir. Med. 2025, 93(1), 3; https://doi.org/10.3390/arm93010003 - 6 Feb 2025

Abstract

Background: Asthma significantly impacts global health, necessitating effective management strategies. A combination of inhaled corticosteroids (ICSs) and long-acting β2-agonists (LABA) is recommended for patients with inadequately controlled asthma. Method: This prospective, open-label, multicenter study (PROMISING-SHIFT) study evaluated the safety and efficacy of once-daily [...] Read more.

Background: Asthma significantly impacts global health, necessitating effective management strategies. A combination of inhaled corticosteroids (ICSs) and long-acting β2-agonists (LABA) is recommended for patients with inadequately controlled asthma. Method: This prospective, open-label, multicenter study (PROMISING-SHIFT) study evaluated the safety and efficacy of once-daily Indacaterol/Mometasone (IND/MF) dry powder inhaler (DPI) in Indian asthma patients (≥12 years), inadequately controlled with prior therapies. Patients received IND/MF DPI in three strengths (150/80 mcg, 150/160 mcg, 150/320 mcg) over 12 weeks. Results: The study included a total of 174 participants, and 27 adverse events (AEs) in 25 patients (14.37%) were reported, primarily mild to moderate, with no serious adverse events (SAEs). Drug-related treatment-emergent adverse events (TEAEs) were observed in 11 patients. Significant improvements were noted in the mean trough FEV1 and FVC, increasing from baseline to week 4 and week 12 (p < 0.001). The mean ACQ-5 score significantly decreased from 3.0 ± 0.73 baseline to 2.50 ± 0.53 (16.67%) at week 4 and further to 1.73 ± 0.35 at week 12, along with reduced exacerbations (p < 0.001). The need for rescue medication declined from 13.79% to 8.62%, and 96.55% of patients reported treatment satisfaction by study completion. Conclusion: Once-daily IND/MF DPI demonstrated a favorable safety profile with marked improvements in lung function, asthma control, and patient satisfaction, making it a promising option for long-term asthma management in Indian patients. Full article

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11 pages, 894 KiB

Open AccessArticle

The Role of Impulse Oscillometry in Detection of Preserved Ratio Impaired Spirometry (PRISm)

by Chalerm Liwsrisakun, Warawut Chaiwong, Athavudh Deesomchok, Pilaiporn Duangjit and Chaicharn Pothirat

Adv. Respir. Med. 2025, 93(1), 2; https://doi.org/10.3390/arm93010002 - 27 Jan 2025

Abstract

Background: Information is limited regarding the role of impulse oscillometry (IOS) for the detection of preserved ratio impaired spirometry (PRISm). Therefore, we aimed to study the diagnostic ability of IOS in differentiating between PRISm and healthy subjects. Methods: This retrospective data collection was [...] Read more.

Background: Information is limited regarding the role of impulse oscillometry (IOS) for the detection of preserved ratio impaired spirometry (PRISm). Therefore, we aimed to study the diagnostic ability of IOS in differentiating between PRISm and healthy subjects. Methods: This retrospective data collection was done at the Lung Health Center, Faculty of Medicine, Chiang Mai University, Thailand between July 2019 and April 2022. The potential diagnostic possibilities of difference in resistance at 5 Hz (R5) and resistance at 20 Hz (R20) (R5-R20) for PRISm detection were analyzed. Results: The prevalence of PRISm was higher when using the fixed ratio (FR) criteria (FEV₁/FVC ≥0.7 with FEV₁ < 80% of predicted value) compared to the lower limit of normal (LLN) criteria (FEV₁/FVC ≥ LLN and FEV₁ < LLN) (10.0% vs. 4.2%). The %prediction for R5-R20 provided an acceptable area under the curve (AUC) for PRISm, defined by the LLN and the FR criteria (AuROC = 0.75 (95%CI; 0.64, 0.85) and 0.72 (95%CI; 0.63, 0.81), respectively). The cut-off value of %predicted R5-R20 ≥120% resulted in the highest sensitivity and specificity for detecting PRISm. Conclusions: The %predicted of R5-R20 ≥ 120% showed an acceptable performance for PRISm detection and PRISm may be detected by IOS. Full article

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7 pages, 645 KiB

Open AccessCommunication

Evaluating the Effect of Body Mass Index on Procalcitonin Level in Patients with Pneumonia: A Retrospective Cross-Sectional Study

by Mohammad Z. Khrais, J. Curran Henson, Jake Smith and Nikhil Meena

Adv. Respir. Med. 2025, 93(1), 1; https://doi.org/10.3390/arm93010001 - 26 Jan 2025

Abstract

Procalcitonin (PCT) is commonly used to evaluate the etiology and severity of pneumonia. PCT has been shown to be elevated at baseline in patients with obesity. The aim of this study is to determine if body mass index (BMI) has an influence on [...] Read more.

Procalcitonin (PCT) is commonly used to evaluate the etiology and severity of pneumonia. PCT has been shown to be elevated at baseline in patients with obesity. The aim of this study is to determine if body mass index (BMI) has an influence on admission PCT level in patients admitted to the hospital with a diagnosis of pneumonia. We conducted a retrospective cohort study that encompassed patient visits to a tertiary care center from 2014 until September 2023. A total of 18,652 patients presented to the emergency department with a diagnosis of pneumonia. A total of 3659 were admitted to the floor, and 2246 were admitted to the MICU. Patients were grouped based on admission BMI into five categories. The Kruskal–Wallis test performed on patients admitted to the floor revealed a statistically significant difference in PCT levels among groups of different BMIs (H = 34.97, df = 4, p < 0.001). In patients admitted to the MICU, the Kruskal–Wallis test revealed a significant difference in PCT levels among groups of different BMIs (H = 32.92, df = 4, p < 0.001). BMI has a statistically significant effect on PCT in patients admitted to the hospital with pneumonia. Patients with higher BMI may exhibit less robust PCT levels, which may impact management decisions. Full article

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14 pages, 2552 KiB

Open AccessBrief Report

Successful Therapy over 12 Months of People with Cystic Fibrosis with Rare Non-phe508del Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Mutations with Elexacaftor/Tezacaftor/Ivacaftor (ETI)

by Tomke Sütering, Sebastian F. N. Bode, Rainald Fischer and Dorit Fabricius

Adv. Respir. Med. 2024, 92(6), 559-572; https://doi.org/10.3390/arm92060049 - 20 Dec 2024

Abstract

Background: Elexacaftor/Tezacaftor/Ivacaftor (ETI) is a CFTR modulator therapy approved for people with cystic fibrosis (pwCF) who have at least one phe508del mutation. However, its approval in the European Union (EU) for pwCF with non-phe508del mutations is lacking, because data on treatment response in [...] Read more.

Background: Elexacaftor/Tezacaftor/Ivacaftor (ETI) is a CFTR modulator therapy approved for people with cystic fibrosis (pwCF) who have at least one phe508del mutation. However, its approval in the European Union (EU) for pwCF with non-phe508del mutations is lacking, because data on treatment response in this subgroup are scarce. Methods: This retrospective observational study evaluated six pwCF (ages 6 to 66) with responsive CFTR mutations (M1101K, R347P, 2789+5G>A, G551D) undergoing off-label ETI therapy. Evaluations were conducted at 0, 3, 6, 9, and 12 months, assessing lung function (FEV₁), sweat chloride levels, body mass index (BMI), quality of life, medication satisfaction, ear, nose and throat (ENT) symptoms, and physical activity. A control group of four pwCF with classic symptoms and no ETI treatment was included. Results: FEV₁ improved significantly after 3 and 6 months (p < 0.05) and stabilized by 12 months. Sweat chloride levels decreased significantly, with four pwCF achieving levels <60 mmol/L. Improvements in the upper and lower airway symptoms, medication satisfaction, and increased BMI were noted. Conclusions: ETI demonstrates high efficacy in this small group of pwCF with rare CFTR mutations, offering a treatment option that warrants further monitoring and evaluation. Full article

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11 pages, 1221 KiB

Open AccessArticle

Association Between Visceral Fat and Lung Function Impairment in Overweight and Grade I Obese Women: A Cross-Sectional Study

by Anamei Silva-Reis, Boris Brill, Maysa Alves Rodrigues Brandao-Rangel, Renilson Moraes-Ferreira, Dobroslav Melamed, Helida Cristina Aquino-Santos, Claudio Ricardo Frison, Regiane Albertini, Rodrigo Álvaro Brandao Lopes-Martins, Luís Vicente Franco de Oliveira, Gustavo Paixao-Santos, Carlos Rocha Oliveira, Asghar Abbasi and Rodolfo P. Vieira

Adv. Respir. Med. 2024, 92(6), 548-558; https://doi.org/10.3390/arm92060048 - 18 Dec 2024

Abstract

Beyond the common comorbidities related to obesity, such as type 2 diabetes and cardiovascular diseases, impaired lung function is already known, but whether the fat distribution (sub-cutaneous, visceral) affects the lung function and pulmonary immune response are poorly known. Few evidence has shown [...] Read more.

Beyond the common comorbidities related to obesity, such as type 2 diabetes and cardiovascular diseases, impaired lung function is already known, but whether the fat distribution (sub-cutaneous, visceral) affects the lung function and pulmonary immune response are poorly known. Few evidence has shown that visceral fat is associated with insulin resistance, low-grade inflammation, and reduced lung function. In the present study, the body composition and fat distribution were evaluated by multi-frequency octopolar bioimpedance. This study demonstrated a possible association of increased visceral fat with impaired lung function in obesity grade I (n = 28; 45.46 ± 10.38 years old) women that was not observed in normal weight (n = 20; 43.20 ± 10.78 years old) and in overweight women (n = 30; 47.27 ± 10.25 years old). We also identified a negative correlation in FVC% (R² = 0.9129; p < 0.0236), FEV1% (R² = 0.1079; p < 0.0134), PEF% (R² = 0.1673; p < 0.0018), and VC IN% (R² = 0.1330; p < 0.0057) in the obesity grade I group, clearly demonstrating that higher levels of visceral fat correlate with reduced lung function, but not with sub-cutaneous fat. In addition, for the first time, a negative correlation among anti-fibrotic protein klotho (R² = 0.09298; p < 0.0897) and anti-inflammatory IL-10 (R² = 0.1653; p < 0.0487) in plasma was observed, in contrast to increased visceral fat. On the contrary, in breath condensate, a positive correlation for adiponectin (R² = 0.5665; p < 0.0120), IL1-Ra (R² = 0.2121; p < 0.0544), and IL1-Beta (R² = 0.3270; p < 0.0084) was found. Thus, increased visceral fat directly influences the impairment of lung function and the systemic and pulmonary immune response of women with obesity grade I. Full article

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10 pages, 266 KiB

Open AccessArticle

Characterization of Serum Cytokine Patterns in Frequent-Exacerbation Asthma: Implications for Phenotyping and Management

by Dao Ngoc Bang, Pham Dac The, Pham Thi Kim Nhung, Nguyen Tien Dung, Bach Quoc Tuan, Vu Minh Duong, Le Thi Dieu Hien and Ta Ba Thang

Adv. Respir. Med. 2024, 92(6), 538-547; https://doi.org/10.3390/arm92060047 - 17 Dec 2024

Abstract

(1) Background: Asthma exacerbations represent significant clinical events, however, the underlying inflammatory mechanisms and cytokine profiles in patients with frequent exacerbations remain incompletely understood; (2) Methods: In this prospective, cross-sectional study of 120 stable asthma patients, we compared the serum concentrations of eight [...] Read more.

(1) Background: Asthma exacerbations represent significant clinical events, however, the underlying inflammatory mechanisms and cytokine profiles in patients with frequent exacerbations remain incompletely understood; (2) Methods: In this prospective, cross-sectional study of 120 stable asthma patients, we compared the serum concentrations of eight key cytokines (IL-4, IL-12, IL-13, IL-17, IFN-α, IFN-γ, TNF-α, and IL-1β) between two groups: 60 patients with frequent exacerbations (≥ 2 events per year) and 60 matched controls with few exacerbations (1 event per year); (3) Results: Patients with frequent exacerbations showed significantly higher serum concentrations of IL-4 and IL-13 (p < 0.05), along with an increased prevalence of allergic history and comorbidities (chronic rhinosinusitis, GERD, OSA; all p < 0.05). The IgE levels correlated positively with IFN-α (rh = 0.26) and TNF-α (rh = 0.29), while the FeNO levels correlated with IL-17 (rh = 0.26) and IL-1β (rh = 0.33) (all p < 0.05); (4) Conclusions: Our findings identify a distinct cytokine signature in frequent exacerbators characterized by elevated IL-4 and IL-13 levels. The correlations between specific cytokines and established biomarkers suggest potential mechanisms underlying exacerbation susceptibility, which may inform targeted therapeutic strategies for this high-risk population. Full article

12 pages, 2010 KiB

Open AccessArticle

Prevalence and Clinical Implications of Pulmonary Vein Stenosis in Bronchiectasis: A 3D Reconstruction CT Study

by Xin Li, Yang Gu, Jinbai Miao, Ying Ji, Mingming Shao and Bin Hu

Adv. Respir. Med. 2024, 92(6), 526-537; https://doi.org/10.3390/arm92060046 - 16 Dec 2024

Abstract

Background: Recent studies on bronchiectasis have revealed significant structural abnormalities and pathophysiological changes. However, there is limited research focused on pulmonary venous variability and congenital variation. Through our surgical observations, we noted that coarctation of pulmonary veins and atrophied lung volume are relatively [...] Read more.

Background: Recent studies on bronchiectasis have revealed significant structural abnormalities and pathophysiological changes. However, there is limited research focused on pulmonary venous variability and congenital variation. Through our surgical observations, we noted that coarctation of pulmonary veins and atrophied lung volume are relatively common in bronchiectasis patients. Therefore, we conducted a retrospective study to explore pulmonary venous variation and secondary manifestations in bronchiectasis cases, utilizing 3D reconstruction software (Mimics Innovation Suite 21.0, Materialise Dental, Leuven, Belgium) to draw conclusions supported by statistical evidence. Method: This retrospective study included patients with bronchiectasis and healthy individuals who underwent CT examinations at Beijing Chao-Yang Hospital between January 2017 and July 2023. Chest CT data were reconstructed using Materialise Mimics. Pulmonary veins and lung lobes were segmented from surrounding tissue based on an appropriate threshold determined by local grey values and image gradients. Subsequently, venous cross-sectional areas and lung volumes were measured for statistical analysis. Result: CT data from 174 inpatients with bronchiectasis and 75 cases from the health examination center were included. Three-dimensional reconstruction data revealed a significant reduction in cross-sectional areas of pulmonary veins in the left lower lobe (p < 0.001), the right lower lobe (p = 0.030), and the right middle lobe (p = 0.009) of bronchiectasis patients. Subgroup analyses indicated that approximately 73.5% of localized cases of the left lower lobe exhibited pulmonary vein stenosis, while in the diffuse group, this proportion was only 52.6%. Furthermore, the cross-sectional area of pulmonary veins had a gradually decreasing trend, based on a small sample. Lung function tests showed significant reductions in FEV1, FVC, and FEV1% in bronchiectasis patients, attributed to the loss of lung volume in the left lower lobe, which accounted for 60.9% of the included sample. Conclusions: Our recent findings suggest that pulmonary venous stenosis is a common variation in bronchiectasis and is often observed concurrently with reduced lung volume, particularly affecting the left lower lobe. Moreover, localized cases are more likely to suffer from pulmonary venous stenosis, with an ambiguous downtrend as the disease progresses. In conclusion, increased attention to pulmonary venous variation in bronchiectasis is warranted, and exploring new therapies to intervene in the early stages or alleviate obstruction may be beneficial. Full article

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