Daily Respiratory Research Analysis

RATIONALE: Survivors of preterm birth (<37 weeks' gestation) have low peak oxygen uptake, a global measure of aerobic fitness and an established predictor of increased morbidity and mortality. However, little is known about other cardiopulmonary outcome measures in this population. We addressed the hypothesis that preterm birth is associated with abnormal respiratory, cardiovascular and metabolic responses to exercise, as assessed by cardiopulmonary exercise testing, METHODS: Six databases were systematically searched up to 29 November 2024 (PROSPERO: CRD42022320775). Studies reporting cardiopulmonary outcome measures obtained during a standardised exercise test were included if they had preterm-born participants and matched term-born controls. The standardised mean difference (SMD) between pooled preterm-born and term-born cohorts was calculated using random-effects models for the meta-analysis. RESULTS: Of the 12 143 records identified, 47 cohorts were included in the final meta-analysis. At peak exercise, the preterm-born cohort (n=2149) demonstrated lower oxygen uptake (SMD -0.39, 95% CI -0.52 to -0.26), work rate (SMD -0.53, 95% CI -0.70 to -0.35), minute ventilation (SMD -0.43, 95% CI -0.60 to -0.26), tidal volume (SMD -0.38, 95% CI -0.62 to -0.15), oxygen pulse (SMD -0.47, 95% CI -0.75 to -0.19), heart rate (SMD -0.18, 95% CI -0.28 to -0.07), anaerobic threshold (SMD -0.29, 95% CI -0.49 to -0.08) and gas exchange efficiency (SMD 0.22, 95% CI 0.04 to 0.41), compared to the term-born cohort (n=1650). CONCLUSIONS: In addition to a reduced peak oxygen uptake, survivors of preterm birth have impairments in the respiratory, cardiovascular and metabolic domains during cardiopulmonary exercise testing. Given that reduced aerobic capacity is associated with increased morbidity and mortality, exercise interventions that target cardiorespiratory fitness should be prioritised across the lifespan in those born preterm.

BACKGROUND: Checkpoint inhibitor-related pneumonia (CIP) is a complication of immune checkpoint inhibitors (ICIs) with high mortality. There is still a lack of effective biomarkers to identify CIP. Exhaled nitric oxide (eNO), an airway inflammatory marker, can be obtained by non-invasive methods, but its value in CIP is unknown. The purpose of this study was to investigate the value of eNO in CIP. METHODS: Lung cancer patients who received ICIs were included at Nanfang Hospital, Southern Medical University. Fractional eNO at expiratory flow rates of 50 and 200 mL/s (FeNO50 and FeNO200) were measured. The alveolar concentration of nitric oxide (CaNO) was calculated based on the two-compartment model of airway and alveoli. The optimal CaNO cut-off value was determined by the receiver operating characteristic (ROC) curve. eNO, clinical characteristics, and laboratory tests were analyzed to find out the risk factors for CIP by logistic regression analysis. A multi-indicator model based on best risk factors for CIP was developed and internally validated. RESULTS: CaNO was significantly elevated in the CIP group [8.1±5.0 CONCLUSIONS: CaNO may be a new marker for identifying CIP. Increased CaNO, pre-existing radiotherapy and emphysema reported on chest CT, a small amount of pleural effusion reported on chest CT, and lower count of lymphocyte cell in peripheral blood are independently associated with CIP.

BACKGROUND: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with increasing prevalence and mortality worldwide. Coinfection with chronic pulmonary aspergillosis (CPA) is a significant complication of NTM-PD, often complicating treatment and resulting in poor prognosis. OBJECTIVE: In this multicentre, retrospective cohort study, we examined the epidemiology, comorbidities, risk factors for CPA coinfection and long-term prognosis of patients with NTM-PD infected with CPA in Japan. METHODS: Patients aged ≥ 18 years with newly diagnosed NTM-PD who visited 18 hospitals between 2010 and 2017 in Kyushu, Japan, were included. Medical records were reviewed for patient characteristics, mycobacterial species, laboratory data, radiological features, Aspergillus coinfection and all-cause mortality rates. Risk factors for CPA coinfection were analysed using multiple logistic regression, and survival analysis was performed before and after propensity score matching with risk factors. RESULTS: Among 1304 patients with NTM-PD, 45 (3.5%) were diagnosed with CPA, including 42 with chronic progressive pulmonary aspergillosis. The risk factors for CPA coinfection included male sex, chronic obstructive pulmonary disease, oral corticosteroid use and cavity formation. All-cause mortality was significantly higher in patients with NTM-PD with CPA than in those without CPA (log-rank test, p < 0.001; crude hazard ratio [HR], 3.98). Survival analysis after propensity score matching suggested CPA was an independent poor prognostic factor (log-rank test, p = 0.036; adjusted HR, 1.59). CONCLUSION: CPA is an independent poor prognostic factor in patients with NTM-PD. Clinicians must consider CPA when treating patients with NTM-PD, particularly those with high-risk factors, to ensure timely diagnosis and management.