Advances in Respiratory Medicine

17 pages, 1802 KiB

Open AccessArticle

Diagnostic Efficacy of C-Reactive Protein in Differentiating Various Causes of Exudative Pleural Effusion: Disease Research Should Not Be Exclusive to the Wealthy

by Majed Odeh, Yana Kogan and Edmond Sabo

Adv. Respir. Med. 2025, 93(4), 29; https://doi.org/10.3390/arm93040029 - 5 Aug 2025

Abstract

Background and Objectives: Discrimination between various causes of exudative pleural effusion (PE) remains a major clinical challenge, and to date, definitive biochemical markers for this discrimination remain lacking. An increasing number of studies have reported that serum C-reactive protein (CRPs), pleural fluid [...] Read more.

Background and Objectives: Discrimination between various causes of exudative pleural effusion (PE) remains a major clinical challenge, and to date, definitive biochemical markers for this discrimination remain lacking. An increasing number of studies have reported that serum C-reactive protein (CRPs), pleural fluid CRP (CRPpf), and CRPpf/CRPs ratio (CRPr) are useful for the differential diagnosis of exudative PE; however, their efficacy rate is not similar in these studies. The majority of these studies were conducted on small groups of subjects, and the efficacy of the gradient between CRPs and CRPpf (CRPg—calculated as CRPs—CRPpf) in this differentiation has not been previously investigated. This study aims to evaluate the efficacy rate of CRPs, CRPpf, CRPg, and CRPr in the differential diagnoses of various causes of exudative PE in a relatively large cohort of patients. Materials and Methods: The research group included 282 subjects with exudative PE—146 had parapneumonic effusion (PPE), 126 had malignant pleural effusion (MPE), and 10 had tuberculous pleural effusion (TPE). The values are presented as mean ± SD. Results: The mean CRPs level was significantly higher in the PPE group compared to the MPE group (p < 0.0001) and the TPE group (p < 0.001), and also significantly higher in the TPE group than in the MPE group (p = 0.0009). Similarly, the mean CRPpf level was significantly higher in the PPE group than in the MPE group (p < 0.0001) and the TPE group (p = 0.04), and also significantly higher in the TPE group than in the MPE group (p < 0.0001). The mean CRPg level was significantly higher in the PPE group than in both the MPE group (p < 0.0001) and the TPE group (p < 0.002). The mean CRPr level did not differ significantly among these groups of exudate. Conclusions: CRPs, CRPpf, and CRPg are effective in the differential diagnosis of exudative PE, while CRPr was not effective in this regard. The main limitation of this study is that the sample size of the TPE group is very small. Full article

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12 pages, 246 KiB

Open AccessArticle

Tobacco-Free Schools in Practice: Policy Presence and Enforcement in Baltimore Schools

by Chidubem Egboluche, Rifath Ara Alam Barsha, Shervin Assari, Michelle Mercure, Marc Laveau, Oluwatosin Olateju and Payam Sheikhattari

Adv. Respir. Med. 2025, 93(4), 28; https://doi.org/10.3390/arm93040028 - 5 Aug 2025

Abstract

Background: School-based tobacco control policies are critical for preventing youth tobacco use. While many districts adopt formal policies to create smoke- and vape-free environments, the degree to which these policies are enforced at the school level may vary, influencing their effectiveness. Little is [...] Read more.

Background: School-based tobacco control policies are critical for preventing youth tobacco use. While many districts adopt formal policies to create smoke- and vape-free environments, the degree to which these policies are enforced at the school level may vary, influencing their effectiveness. Little is known about how consistently such policies are implemented across schools within urban school districts. Objectives: This study aimed to examine the existence and enforcement of school-level tobacco control policies in an urban public school system, using Baltimore City schools as a case example. Methods: We conducted a survey of school personnel from 20 high schools in Baltimore City in 2024. The survey instrument assessed the presence and enforcement of policies related to tobacco use prevention, communication, signage, disciplinary actions, and institutional support. Descriptive statistics (frequencies and percentages) were used to summarize responses. Spearman correlations were also used for bivariate correlations. Additional school-level and neighborhood-level contextual data were collected from the internet (neighborhood socioeconomic status and school performance). Results: While many policies existed across the 20 participating schools, their enforcement was widely inconsistent. Most schools reported the existence of policies prohibiting tobacco use in school buildings (60%) and vehicles (55%). However, few schools had visible tobacco-free signage (35%) or offered cessation programs (15%). Communication of policies to students (70%) and staff (65%) was the most commonly enforced aspect of tobacco control policies. Conclusions: Findings suggest that while tobacco control policies may be adopted across urban school systems, their enforcement at the school level remains uneven. Greater attention may be needed to support policy implementation and to reduce variability in school-level practices. Baltimore City serves as a useful case study to understand these challenges and identify opportunities for strengthening school-based tobacco prevention efforts. Full article

13 pages, 1397 KiB

Open AccessArticle

RSPH4A-PCDx: An Index to Predict Lung Function Decline in Primary Ciliary Dyskinesia

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

Adv. Respir. Med. 2025, 93(4), 27; https://doi.org/10.3390/arm93040027 - 2 Aug 2025

Abstract

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder that impairs mucociliary clearance and leads to progressive lung disease. This study aimed to characterize lung function decline in a genetically homogeneous cohort of Puerto Rican patients with RSPH4A-associated PCD and to [...] Read more.

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder that impairs mucociliary clearance and leads to progressive lung disease. This study aimed to characterize lung function decline in a genetically homogeneous cohort of Puerto Rican patients with RSPH4A-associated PCD and to develop a clinical tool to predict lung function decline and support transplant referral decisions. We conducted a retrospective chart review of patients (n = 25) with a confirmed RSPH4A [c.921+3_6delAAGT] genetic variant, collecting longitudinal spirometry data and applying linear regressions to calculate each patient’s individual FEV₁ decline. The median FEV₁ at diagnosis was 55%, with a median annual decline of −0.75% predicted. Adults exhibited significantly lower lung function compared to pediatric patients, while no difference was seen between males and females. Based on this observed decline, we developed the Predicted Capacity Decline Index (PCDx), an index that estimates the age and time until a patient reaches the 30% FEV₁ threshold, the point at which lung transplant referral is typically considered. Our findings underscore the need for early intervention and suggest that genotype-specific tools like the PCDx may enhance clinical decision-making in managing progressive lung disease in PCD. Full article

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11 pages, 254 KiB

Open AccessArticle

Investigation of Individual Variability and Temporal Fluctuations in Exhaled Nitric Oxide (FeNO) Levels in Healthy Individuals

by Emi Yuda, Tomoki Ando, Yukihiro Ishida, Hiroyuki Sakano and Yutaka Yoshida

Adv. Respir. Med. 2025, 93(4), 26; https://doi.org/10.3390/arm93040026 - 21 Jul 2025

Abstract

Measurement of nitric oxide (NO) concentration in exhaled breath (FeNO) is a quantitative, non-invasive, simple, and safe method for assessing airway inflammation. It serves as a complementary tool to other methods for evaluating airway diseases. However, little is known about the typical NO [...] Read more.

Measurement of nitric oxide (NO) concentration in exhaled breath (FeNO) is a quantitative, non-invasive, simple, and safe method for assessing airway inflammation. It serves as a complementary tool to other methods for evaluating airway diseases. However, little is known about the typical NO levels in healthy individuals, including individual differences and the influence of measurement timing. Therefore, this study classified measurement times into four periods and statistically analyzed NO levels in healthy individuals. The mean values among groups were compared using repeated measures ANOVA on six participants. The analysis showed large individual variations in NO levels, resulting in no significant difference (p = 0.29). Notably, greater fluctuations were observed in the morning. These findings align with previous studies suggesting the influence of circadian rhythms and the redundancy of repeated measurements. This study highlights the need to consider timing and individual variability when using FeNO as a physiological marker in healthy populations. Full article

11 pages, 655 KiB

Open AccessArticle

A Comparison of Impulse Oscillometry and Spirometry by Percent Predicted in Identifying Uncontrolled Asthma

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

Adv. Respir. Med. 2025, 93(4), 25; https://doi.org/10.3390/arm93040025 - 18 Jul 2025

Abstract

Background: The role of impulse oscillometry (IOS) in evaluating asthma control remains a challenge because the interpretation varies by many factors, including ethnicity. We aimed to assess the diagnostic contribution of spirometry and IOS, established from reference equations, in the detection of uncontrolled [...] Read more.

Background: The role of impulse oscillometry (IOS) in evaluating asthma control remains a challenge because the interpretation varies by many factors, including ethnicity. We aimed to assess the diagnostic contribution of spirometry and IOS, established from reference equations, in the detection of uncontrolled asthma. Methods: This retrospective study was conducted in adult asthma subjects with normal spirometry. Uncontrolled asthma was defined as an Asthma Control Test (ACT) score ≤ 19. Receiver operating characteristic (ROC) curves were plotted to compare the diagnostic abilities of the %-predicted of heterogeneity of resistance at 5 Hz and 20 Hz (R5-R20) and the %-predicted of forced expiratory volume in the first second (FEV₁) in detecting uncontrolled asthma. Multivariable risk regressions were performed to identify the %-predicted of R5-R20 as a predictor for uncontrolled asthma. Results: The %-predicted of R5-R20 demonstrated a superior diagnostic ability for detecting uncontrolled asthma compared to the %-predicted FEV₁, with the area under the ROC curves (AuROC) = 0.939 vs. 0.712, respectively, p < 0.001. The %-predicted R5R20 of ≥200 showed the highest AuROC for detecting uncontrolled asthma with an adjusted risk ratio of 10.86 (95%CI; 3.77, 31.29; p < 0.001). Conclusions: IOS demonstrated better diagnostic ability for detecting uncontrolled asthma than spirometry. Full article

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17 pages, 3718 KiB

Open AccessArticle

Pharmacological Immunomodulation via Collagen–Polyvinylpyrrolidone or Pirfenidone Plays a Role in the Recovery of Patients with Severe COVID-19 Through Similar Mechanisms of Action Involving the JAK/STAT Signalling Pathway: A Pilot Study

by Hugo Mendieta-Zerón, Esteban Cruz-Arenas, Salvador Díaz-Meza, Alejandro Cabrera-Wrooman, Edna Ayerim Mandujano-Tinoco, Rosa M. Salgado, Hugo Tovar, Daniel Muñiz-García, Laura Julieta Orozco-Castañeda, Sonia Hernández-Enríquez, Miriam Deyanira Rodríguez-Piña, Ana Sarahí Mulia-Soto, José Meneses-Calderón, Paul Mondragón-Terán and Edgar Krötzsch

Adv. Respir. Med. 2025, 93(4), 24; https://doi.org/10.3390/arm93040024 - 18 Jul 2025

Abstract

The therapeutic target of COVID-19 is focused on controlling inflammation and preventing fibrosis. Collagen–polyvinylpyrrolidone (collagen-PVP) and pirfenidone both have the ability to control the cytokine storm observed in rheumatic and fibrotic disorders. In this work, our aim was to understand the benefits of [...] Read more.

The therapeutic target of COVID-19 is focused on controlling inflammation and preventing fibrosis. Collagen–polyvinylpyrrolidone (collagen-PVP) and pirfenidone both have the ability to control the cytokine storm observed in rheumatic and fibrotic disorders. In this work, our aim was to understand the benefits of treatment with each of these drugs in patients with severe COVID-19. In total, 36 patients were treated with dexamethasone and enoxaparin, but 26 were allocated collagen-PVP or pirfenidone (n = 15 and 11, respectively); the clinical and metabolic effects were compared among them. Since pirfenidone works via transcriptional mechanisms, we performed a human genome microarray assay using RNA isolated from fibroblast and monocyte cultures treated with the biodrug, with the aim of hypothesising a possible mechanism of action for collagen-PVP. Our results showed that hospital stay duration, quick COVID-19 severity index (qCSI), and admission to the intensive care unit were statistically significantly lower (p < 0.02) in patients treated with collagen-PVP or pirfenidone when compared with the control group, and that only collagen-PVP normalised serum glucose at discharge. Ingenuity Pathway Analysis showed that the cell cycle, inflammation, and cell surface–extracellular matrix interactions could be regulated with collagen-PVP via the downmodulation of proinflammatory cytokines, while Th2 anti-inflammatory response signalling could be upregulated. Furthermore, the downregulation of some of the genes involved in nitric oxide production showed a possible control for JAK in the IFN-γ pathway, allowing for the possibility of controlling inflammation through the JAK/STAT pathway, as has been observed for pirfenidone and other immunomodulators, such as ruxolitinib. Full article

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18 pages, 797 KiB

Open AccessReview

Impact of Invasive Mechanical Ventilation on the Lung Microbiome

by Jose Luis Estela-Zape, Valeria Sanclemente-Cardoza, Maria Alejandra Espinosa-Cifuentes and Leidy Tatiana Ordoñez-Mora

Adv. Respir. Med. 2025, 93(4), 23; https://doi.org/10.3390/arm93040023 - 1 Jul 2025

Abstract

The lung microbiota is integral to maintaining microenvironmental homeostasis, influencing immune regulation, host defense against pathogens, and overall respiratory health. The dynamic interplay among the lung microbiota emphasizes their significance in shaping the respiratory milieu and potential impact on diverse pulmonary affections. This [...] Read more.

The lung microbiota is integral to maintaining microenvironmental homeostasis, influencing immune regulation, host defense against pathogens, and overall respiratory health. The dynamic interplay among the lung microbiota emphasizes their significance in shaping the respiratory milieu and potential impact on diverse pulmonary affections. This investigation aimed to identify the effects of invasive mechanical ventilation on the lung microbiome. Materials and Methods: A systematic review was conducted with registration number CRD42023461618, based on a search of PubMed, SCOPUS, and Web of Science databases, in line with the PRISMA guidelines. To achieve this, “(mechanical ventilation) AND (microbiota)” was used as the search term, replicable across all databases. The closing date of the search was 12 March 2025, and the evidence was scored using the MINORS scale. Results: A total of 16 studies were included, with patients aged 13.6 months to 76 years, predominantly male (64.2%). Common ICU admission diagnoses requiring invasive mechanical ventilation (IMV) included pneumonia, acute respiratory failure, and COVID-19. IMV was associated with reduced lung microbiota diversity and an increased prevalence of pathogenic bacteria, including Prevotella, Streptococcus, Staphylococcus, Pseudomonas, and Acinetobacter. The most frequently used antibiotics were cephalosporins, aminoglycosides, and penicillins. IMV-induced pulmonary dysbiosis correlated with higher infection risk and mortality, particularly in pneumonia and COVID-19 cases. Factors such as antimicrobial therapy, enteral nutrition, and systemic inflammation contributed to these alterations. Conclusions: Invasive mechanical ventilation has been associated with the development of alterations in the respiratory microbiome, resulting in reduced diversity of lung microorganisms. Full article

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15 pages, 588 KiB

Open AccessArticle

Imaging and Laboratory Results as Predictors of the Course of COVID-19

by Ewelina Tobiczyk, Hanna Maria Winiarska, Daria Springer, Aleksandra Ludziejewska, Ewa Wysocka, Szymon Skoczyński and Szczepan Cofta

Adv. Respir. Med. 2025, 93(4), 22; https://doi.org/10.3390/arm93040022 - 1 Jul 2025

Abstract

Background: COVID-19 most often affects the respiratory system and may manifest as acute respiratory failure requiring the use of non-invasive respiratory support (NIRS). The aim of this study was to find predictors based on laboratory results and chest computed tomography (CT) scans performed [...] Read more.

Background: COVID-19 most often affects the respiratory system and may manifest as acute respiratory failure requiring the use of non-invasive respiratory support (NIRS). The aim of this study was to find predictors based on laboratory results and chest computed tomography (CT) scans performed on admission to the hospital indicating the need for NIRS and predicting mortality after hospital discharge. Methods: We retrospectively analysed data from consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from 1 February 2021 to 31 March 2022. Upon admission to the department, the patients underwent a series of laboratory blood tests and high-resolution chest CT scan. Results: The study group included 282 patients, with an average age of 60.0 ± 15.0 years. In total, 54 (53%) patients of 101 requiring NIRS died from various causes or required intubation. Patients who required NIRS were significantly older and had more severe changes in the lung parenchyma. They had higher white blood cell and neutrophil counts and lower lymphocyte counts, as well as higher concentrations of D-dimer, CRP, PCT, and IL-6 and greater activities of LDH and AST. Conclusions: Laboratory tests and chest CT performed on hospital admission may be useful to rapidly identify patients at higher risk for severe disease. Full article

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20 pages, 1384 KiB

Open AccessArticle

The Comparative Effectiveness of Mepolizumab and Benralizumab in the Treatment of Eosinophilic Asthma

by Aleksandra Niemiec-Górska, Olga Branicka, Paula Olszewska, Sylwia Mielcarska, Joanna Glück, Barbara Rymarczyk and Radosław Gawlik

Adv. Respir. Med. 2025, 93(4), 21; https://doi.org/10.3390/arm93040021 - 20 Jun 2025

Abstract

Background: Severe asthma is associated with significant morbidity and risk of complications. Some patients, suffering from eosinophilic asthma, may benefit from biological therapies, especially anti IL-5 (anti-interleukin-5). The purpose of the study was to compare the efficacy evaluation of mepolizumab and benralizumab in [...] Read more.

Background: Severe asthma is associated with significant morbidity and risk of complications. Some patients, suffering from eosinophilic asthma, may benefit from biological therapies, especially anti IL-5 (anti-interleukin-5). The purpose of the study was to compare the efficacy evaluation of mepolizumab and benralizumab in the treatment of eosinophilic asthma. Methods: A retrospective, single-centre study including 59 patients with severe eosinophilic asthma treated with biologics (mepolizumab and benralizumab). Clinical outcomes, including peripheral blood morphotic characteristics, spirometry parameters, asthma control questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ) scores, daily oral corticosteroid use, body mass index, exacerbation rate, and exercise tolerance, were examined at the beginning and after 6 months of biological treatment. Results: A total of 38 patients were treated with mepolizumab and 21 with benralizumab. Significant improvements (p < 0.05) in eosinophil count, required daily dose of glucocorticoids, ACQ, mini-AQLQ scores, and exacerbation rate were observed in both groups after six months of treatment. There was no statistical difference (p < 0.05) in the abovementioned parameters between the groups. Conclusions: In patients with severe eosinophilic asthma, mepolizumab and benralizumab were associated with significant improvements in clinical state. Patients with type 2 asthma will benefit from the therapy with both anti-IL5 biologic drugs. Full article

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7 pages, 398 KiB

Open AccessArticle

Evaluating Obstructive Sleep Apnea Utilizing Arterial Tonometry in Individuals with Cystic Fibrosis

by Michelle Chiu, Bethany Bartley, Elizabeth Gootkind, Salma Batool-Anwar, Donald G. Keamy, Thomas Bernard Kinane, Lael M. Yonker and Kevin S. Gipson

Adv. Respir. Med. 2025, 93(3), 20; https://doi.org/10.3390/arm93030020 - 17 Jun 2025

Abstract

Poor sleep quality and excessive daytime sleepiness are commonly reported by individuals with cystic fibrosis. The potential impact of comorbid sleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA), has not been extensively studied in the CF population. At present, there are no specific [...] Read more.

Poor sleep quality and excessive daytime sleepiness are commonly reported by individuals with cystic fibrosis. The potential impact of comorbid sleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA), has not been extensively studied in the CF population. At present, there are no specific recommendations available to help clinicians identify patients with CF who are at increased risk of sleep disorders. Home sleep apnea testing using a validated peripheral arterial tonometry (PAT) device may offer an accurate diagnosis of OSA in a more convenient and low-cost method than in-lab polysomnography. In this single-center study of 19 adults with CF, we found an increased prevalence of OSA among individuals with CF compared to general population estimates. Although associations with an FEV < 70% predicted and a modified Mallampati score ≥ 3 were observed, these odds ratios did not reach statistical significance, likely reflecting limited power in this small pilot sample. There was no association found between the self-reported presence of nocturnal cough or snoring and OSA. We also found no association between OSA and abnormal scores on commonly used, validated sleep questionnaires, suggesting that CF-specific scales may be needed for effective screening in the CF clinic. Full article

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18 pages, 3326 KiB

Open AccessArticle

Harnessing Natural Product Compounds to Target Dormancy Survival Regulator (DosR) in Latent Tuberculosis Infection (LTBI): An In Silico Strategy Against Dormancy

by Mandeep Chouhan, Mukesh Kumar, Vivek Dhar Dwivedi, Vivek Kumar Kashyap, Himanshu Narayan Singh and Sanjay Kumar

Adv. Respir. Med. 2025, 93(3), 19; https://doi.org/10.3390/arm93030019 - 16 Jun 2025

Abstract

Dormancy occurs when Mycobacterium tuberculosis (Mtb) enters a non-replicating and metabolically inactive state in response to hostile environment. During this state, it is highly resistant to conventional antibiotics, which increase the urgency to develop new potential drugs against dormant bacilli. In view of [...] Read more.

Dormancy occurs when Mycobacterium tuberculosis (Mtb) enters a non-replicating and metabolically inactive state in response to hostile environment. During this state, it is highly resistant to conventional antibiotics, which increase the urgency to develop new potential drugs against dormant bacilli. In view of this, the dormancy survival regulator (DosR) protein is thought to be an essential component that plays a key role in bacterial adaptation to dormancy during hypoxic conditions. Herein, the NP-lib database containing natural product compounds was screened virtually against the binding site of the DosR protein using the MTiopen screen web server. A series of computational analyses were performed, including redocking, intermolecular interaction analysis, and MDS, followed by binding free energy analysis. Through screening, 1000 natural product compounds were obtained with docking energy ranging from −8.5 to −4.1 kcal/mol. The top four lead compounds were then selected for further investigation. On comparative analysis of intermolecular interaction, dynamics simulation and MM/GBSA calculation revealed that M3 docked with the DosR protein (docking score = −8.1 kcal/mol, RMSD = ~7 Å and ΔG Bind = −53.51 kcal/mol) exhibited stronger stability than reference compound Ursolic acid (docking score = −6.2 kcal/mol, RMSD = ~13.5 Å and ΔG Bind = −44.51 kcal/mol). Hence, M3 is recommended for further validation through in vitro and in vivo studies against latent tuberculosis infection. Full article

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22 pages, 829 KiB

Open AccessArticle

Medication Recommendation, Counseling, and Pricing for Nasal Sprays in German Community Pharmacies: A Simulated Patient Investigation

by Bernhard Langer, Christian Kunow, Tim Dethloff and Sarah George

Adv. Respir. Med. 2025, 93(3), 18; https://doi.org/10.3390/arm93030018 - 13 Jun 2025

Abstract

For the self-medication of nasal congestion following a common cold, decongestant nasal sprays can be recommended according to the medicine guidelines. In Germany, these are only available in community pharmacies (CPs) with free pricing. The aim was to analyze the medication recommendation, counseling, [...] Read more.

For the self-medication of nasal congestion following a common cold, decongestant nasal sprays can be recommended according to the medicine guidelines. In Germany, these are only available in community pharmacies (CPs) with free pricing. The aim was to analyze the medication recommendation, counseling, and pricing. A covert simulated patient study, internationally recognized as the “gold standard”, was conducted in all CPs of two medium-sized cities in north-eastern Germany. Each CP was visited twice (86 visits) with the identical scenario by one female and one male simulated patient. At the beginning, they asked for a nasal spray and, when asked, stated that they had had nasal congestion for three days. Slightly more than half (54.7%, 47/86) of the recommended nasal sprays were free of preservatives. The median counseling score was 2.0 out of 8 points, with a significantly higher score observed for the female SP (p = 0.004). Information on the maximum intake duration of five days recommended in the German pharmacy guideline was not provided during any visits. The prices varied in total from EUR 1.95 to EUR 6.22. Therefore, measures by the legislator and the chambers of pharmacists are necessary to sustainably improve the medication recommendation, the counseling, and the price transparency. Full article

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16 pages, 734 KiB

Open AccessReview

Clinical Utility of ctDNA Analysis in Lung Cancer—A Review

by Kamil Makar, Agata Wróbel, Adam Antczak and Damian Tworek

Adv. Respir. Med. 2025, 93(3), 17; https://doi.org/10.3390/arm93030017 - 12 Jun 2025

Abstract

Circulating free DNA (cfDNA) is genetic material released from various cells into bodily fluids. Among its fractions, circulating tumor DNA (ctDNA) originates from tumor cells and reflects their genetic material, including mutations and epigenetic changes. Methods commonly employed for detecting ctDNA in blood [...] Read more.

Circulating free DNA (cfDNA) is genetic material released from various cells into bodily fluids. Among its fractions, circulating tumor DNA (ctDNA) originates from tumor cells and reflects their genetic material, including mutations and epigenetic changes. Methods commonly employed for detecting ctDNA in blood include next-generation sequencing (NGS) and various types of PCR. The presence of ctDNA can be utilized in liquid biopsies for many diagnostic purposes related to various cancers. It is a minimally invasive method of sampling molecular compounds from tumor cells. In this paper, we focus on current knowledge regarding the liquid biopsy of blood ctDNA in the context of lung cancer, one of the leading causes of cancer-related mortality. Currently, as a clinically approved method, liquid biopsy serves as a complementary technique in NSCLC diagnostic and genetic profiling. Other applications of liquid biopsy that are still being investigated include the detection of minimal residual disease (MRD) after curative treatment and response monitoring to systemic treatment. This review discusses current and future potential directions for the development and implementation of ctDNA for patients with NSCLC. Full article

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2 pages, 158 KiB

Open AccessReply

Reply to Shafaei B. 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 Andres F. Zea-Vera

Adv. Respir. Med. 2025, 93(3), 16; https://doi.org/10.3390/arm93030016 - 9 Jun 2025

Abstract

I am writing in response to the thoughtful observations [...] Full article

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

Cited by 1

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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Advances in Respiratory Medicine

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