Daily Respiratory Research Analysis
Three impactful studies advance respiratory medicine and public health: (1) the IASLC proposes TNM staging refinements for pulmonary neuroendocrine carcinoma (SCLC/LCNEC), validating new N and M subcategories; (2) a global analysis of asthma (GBD 2021) shows sustained high incidence through 2050 and underscores causal roles for high BMI and smoking; and (3) a large US Veterans cohort compares COVID-19, influenza, and RSV severity, showing higher long-term mortality for COVID-19 and attenuation w
Summary
Three impactful studies advance respiratory medicine and public health: (1) the IASLC proposes TNM staging refinements for pulmonary neuroendocrine carcinoma (SCLC/LCNEC), validating new N and M subcategories; (2) a global analysis of asthma (GBD 2021) shows sustained high incidence through 2050 and underscores causal roles for high BMI and smoking; and (3) a large US Veterans cohort compares COVID-19, influenza, and RSV severity, showing higher long-term mortality for COVID-19 and attenuation with vaccination.
Research Themes
- Oncologic staging and prognostication in pulmonary neuroendocrine carcinoma
- Global respiratory disease burden, risk factors, and forecasting
- Comparative severity of respiratory viral infections and vaccination impact
Selected Articles
1. The International Association for the Study of Lung Cancer Staging Project: The Database and Proposal for the Revision of the Staging of Pulmonary Neuroendocrine Carcinoma in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer.
Using a large international database, the IASLC validated proposed TNM9 refinements for pulmonary NEC: N2a/N2b for single versus multiple ipsilateral mediastinal/subcarinal stations and M1c sub-stratification (M1c1 vs M1c2). These changes held robustly for SCLC; LCNEC showed consistent stage–survival gradients despite smaller numbers.
Impact: Staging governs prognosis, trial eligibility, and management; validating TNM9 refinements in NEC will standardize care and research globally.
Clinical Implications: Adopt TNM9 for SCLC/LCNEC, using N2a/N2b to distinguish single vs multiple ipsilateral mediastinal stations and M1c1/M1c2 to stratify extrathoracic metastatic burden; this should inform prognosis, surgical/RT decisions, and trial stratification.
Key Findings
- Validated N2 subcategories: N2a (single ipsilateral mediastinal/subcarinal station) vs N2b (multiple stations) in SCLC.
- Validated M1c sub-stratification: M1c1 (multiple lesions in one extrathoracic organ system) vs M1c2 (multiple organ systems).
- LCNEC data showed decreasing survival with increasing clinical/pathologic stages despite smaller sample sizes.
Methodological Strengths
- Large, international, contemporary cohort (2011–2019) with survival endpoints.
- Robust survival analyses (Kaplan–Meier, log-rank, Cox) aligned to TNM8 and validating TNM9 proposals.
Limitations
- LCNEC analyses were limited by smaller numbers, restricting full validation across all subgroups.
- Retrospective registry design may harbor residual staging or treatment heterogeneity.
Future Directions: Prospective validation of TNM9 in LCNEC, integration with molecular subtyping, and alignment with treatment algorithms and trial eligibility criteria.
2. Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021.
This GBD-based analysis shows sustained high global asthma incidence through 2050, a rising contribution of high BMI to DALYs since 1990, and Mendelian randomization evidence that high BMI and smoking causally increase asthma risk. Incidence/prevalence track positively with SDI, while mortality/DALYs track negatively.
Impact: Provides up-to-date global burden estimates with causal inference and forecasts, directly informing prevention strategies (obesity/smoking) and long-term planning.
Clinical Implications: Prioritize weight management and smoking cessation in asthma prevention; anticipate sustained service demand to 2050; tailor interventions by SDI and age/sex patterns.
Key Findings
- Global age-standardised asthma incidence projected to remain high from 2022 to 2050 (BAPC model).
- High BMI’s contribution to asthma DALYs increased by 4.3% worldwide between 1990 and 2021.
- Mendelian randomization supports causal effects of high BMI and smoking on asthma risk.
- Incidence/prevalence correlate positively with SDI; mortality/DALYs correlate negatively.
Methodological Strengths
- Combines GBD estimates with joinpoint trends, MR for causality, and BAPC forecasting.
- Large-scale, standardized global datasets enabling cross-country comparisons.
Limitations
- Reliance on secondary data and modeling assumptions; heterogeneity in data quality across regions.
- MR limited by available instruments and potential pleiotropy.
Future Directions: Integrate environmental exposures (air pollution), refine BMI-smoking joint effects, and validate forecasts with prospective surveillance.
3. Severity and Long-Term Mortality of COVID-19, Influenza, and Respiratory Syncytial Virus.
Across two seasons and >140,000 veterans, COVID-19 had higher 180-day mortality than influenza/RSV; 30-day outcomes converged in 2023–2024. Vaccination mitigated severity and long-term mortality differences, with no mortality gap between COVID-19 and influenza among vaccinated individuals.
Impact: Directly informs adult vaccination policies and resource planning by quantifying comparative severity and long-term mortality across major respiratory viruses.
Clinical Implications: Promote up-to-date COVID-19 and influenza vaccination in older/high-risk adults; anticipate prolonged follow-up needs after COVID-19; refine triage during co-circulation seasons.
Key Findings
- In 2023–2024, 30-day hospitalization risk: COVID-19 16.2%, influenza 16.3%, RSV 14.3% (COVID-19 vs RSV RD 1.9%).
- COVID-19 had higher 180-day mortality than influenza and RSV in both seasons (e.g., 2023–2024 RD vs influenza 0.8%).
- Vaccination attenuated severity and mortality differences; among vaccinated, mortality did not differ between COVID-19 and influenza.
Methodological Strengths
- Large, national EHR cohort with inverse probability weighting across two respiratory seasons.
- Direct same-day testing comparison mitigates misclassification across pathogens.
Limitations
- Predominantly older male veterans limit generalizability to broader populations.
- Residual confounding and changes in variant/therapeutics across seasons may influence outcomes.
Future Directions: Extend analyses to diverse populations, evaluate variant-specific risks, and quantify vaccine-effect heterogeneity by platform and timing.