Daily Respiratory Research Analysis
Analyzed 165 papers and selected 3 impactful papers.
Summary
Three studies advance respiratory science and practice: a multicountry analysis quantifies the severe burden and inequalities of rhinovirus/enterovirus hospitalizations; a prospective study shows lung ultrasound can track radiologic progression of RA-associated interstitial lung abnormalities; and a longitudinal cohort links proximity to a drying saline lake and dust events with reduced lung function growth in children.
Research Themes
- Global burden and inequities in non-influenza respiratory viruses
- Radiation-free monitoring of interstitial lung disease progression
- Environmental dust exposure and pediatric lung development
Selected Articles
1. Clinical Characteristics and Severity of Rhinovirus/Enterovirus-Associated Hospitalizations: A Multicountry Analysis From the Global Influenza Hospital Surveillance Network, 2017-2024.
In 7,929 RV/EV-positive hospitalizations across 13 countries, severe outcomes concentrated at the extremes of age, and mortality was substantially higher in lower-middle-income settings. Comorbidities markedly increased ventilation and death risks in children under 5, and age ≥75 predicted in-hospital death in older adults.
Impact: This large, multicountry analysis fills a major evidence gap by quantifying severity and inequities of non-influenza respiratory viruses, informing global surveillance, resource allocation, and vaccine/antiviral prioritization.
Clinical Implications: Integrate RV/EV into routine respiratory virus dashboards, prioritize prevention and inpatient readiness at the extremes of age, and target capacity strengthening in lower-middle-income countries where risk is highest.
Key Findings
- Among 7,929 RV/EV-positive hospitalizations, in-hospital death reached 6.3% (65–74 y) and 9.2% (≥75 y).
- In children <5 years, ≥2 comorbidities strongly predicted mechanical ventilation (aOR 4.62) and death (aOR 3.38 for 1 comorbidity).
- Lower-middle-income settings had markedly higher odds of death in <5-year-olds (aOR 9.94) and older adults (aOR 6.83) versus high-income countries.
Methodological Strengths
- Large, multicountry dataset across income strata with age-stratified mixed-effects modeling
- Adjustment for key confounders including comorbidities, influenza coinfection, and seasonality
Limitations
- Observational design with potential residual confounding and site-level testing variability
- Lack of granularity on specific RV/EV species and viral load
Future Directions: Incorporate RV/EV species typing and genomic surveillance, evaluate vaccine/antiviral candidates in high-risk strata, and quantify resource needs in lower-income settings.
BACKGROUND: Rhinoviruses and enteroviruses (RV/EV) are frequently detected in hospitalized patients with acute respiratory illness; yet, their clinical burden remains under-characterized, particularly across diverse populations and age groups. METHODS: We analyzed Global Influenza Hospital Surveillance Network data collected from November 2017 through October 2024 across 13 countries representing high-, upper-middle-, and lower-middle-income settings. Multivariable mixed-effects logistic regression models, stratified by age (<5, 5-64, ≥65 years) and adjusted for sex, comorbidities, influenza coinfection, country income level, and season, identified risk factors for mechanical ventilation and in-hospital death. RESULTS: Among 7929 RV/EV-positive patients, 62.7%, 24.3%, and 13.0% were aged <5, 5-64, and ≥65 years, respectively. In-hospital death was 6.3% among adults aged 65-74 years and 9.2% among those aged ≥75 years.
2. Lung ultrasound for the detection of radiological progression of interstitial lung abnormalities in patients with rheumatoid arthritis.
In a prospective cohort of RA patients, increases in LUS B-lines predicted HRCT-defined progression of interstitial lung abnormalities (AUC up to 0.82 when combined with DLCO change), outperforming symptom scores and PFTs alone. Blinded HRCT scoring and a 72-zone LUS protocol support reproducibility.
Impact: Demonstrates a radiation-free, scalable tool to monitor RA-ILD progression, enabling earlier risk stratification and potentially reducing HRCT frequency.
Clinical Implications: Incorporate serial LUS (B-lines) into RA-ILD monitoring, especially alongside DLCO changes, to triage patients for HRCT and intensify therapy when progression is detected.
Key Findings
- Radiologic progression occurred in 31% (25/81) over 12–18 months; increases in LUS B-lines were significantly associated (p=0.018).
- Baseline B-lines and their longitudinal increase predicted HRCT progression (AUC 0.78; 95% CI 0.64–0.92).
- Combining LUS metrics with DLCO change achieved AUC 0.82, outperforming symptom scores (AUC 0.58) and PFTs (AUC 0.59).
Methodological Strengths
- Prospective design with blinded HRCT assessment and standardized 72-zone LUS protocol
- Multivariable modeling comparing LUS to symptoms and PFTs with discrimination metrics (AUC)
Limitations
- Single-country pilot with modest sample size and operator dependence of LUS
- External validation and standardized thresholds for actionable B-line changes are needed
Future Directions: Multi-center validation, inter-operator reliability studies, and integration into treat-to-target algorithms for RA-ILD.
OBJECTIVE: Interstitial lung disease is an important extra-articular manifestation of rheumatoid arthritis (RA) associated with high mortality and morbidity. Lung ultrasound (LUS) has recently emerged as a possible screening tool. We assessed the role of lung ultrasound in monitoring radiological progression and the development of new interstitial lung abnormalities (ILA). METHODS: In this prospective pilot study, RA patients underwent high-resolution CT (HRCT), pulmonary function tests (PFTs), symptom assessment, and LUS at baseline and 12-18 months later. B-lines were quantified using a 72-zone protocol. Radiological changes across longitudinal HRCTs were scored on a 5-point Likert scale by blinded thoracic radiologists. Six multivariable logistic regression models were built to predict HRCT progression, using combinations of LUS parameters, PFTs, symptoms, and clinical characteristics. RESULTS: 81 patients completed the follow-up HRCT and per-protocol LUS was performed in 95% (77/81). Radiological progression was observed in 31% (25/81). An increase in B-lines was significantly associated with radiological progression (p=0.018), and a linear trend was confirmed (p=0.026).
3. Distance to a Drying Saline Lake and Lung Function Development in a Rural Border Cohort of Children.
In 369 children contributing 1,146 spirometries over ~2 years, living <11 km from the Salton Sea was associated with 52 mL/year lower FVC growth versus those farther away. Dust storm hours correlated with reduced FVC and FEV1 growth, with stronger effects in children living near the lake.
Impact: Provides longitudinal evidence linking environmental degradation and dust exposure to impaired lung growth in children, informing regional mitigation and public health policy.
Clinical Implications: Clinicians should consider environmental dust exposure in pediatric respiratory assessments, support community mitigation, and advocate for dust control alerts and school-based protections.
Key Findings
- Residence <11 km from the Salton Sea was associated with −52.18 mL/year FVC growth (95% CI −100.96 to −3.40; P=.04).
- Dust storm hours (PM10 >150 μg/m3) were associated with reduced FVC (β= −4.10 mL/y) and FEV1 growth (β= −2.26 mL/y).
- Dust-related FVC decrement was stronger among children living near the lake (P for interaction = .04).
Methodological Strengths
- Longitudinal mixed-effects growth models with repeated spirometry per child
- Community-engaged design with objective dust metrics and covariate adjustment
Limitations
- Regional cohort limits generalizability; exposure misclassification possible
- No statistically significant association for FEV1 by proximity alone
Future Directions: Personal exposure monitoring, mechanistic studies on dust composition, and evaluation of remediation policies’ respiratory benefits.
IMPORTANCE: The Salton Sea, a drying saline lake in southeastern California, is a growing source of wind-blown dust. Its long-term impact on children's lung function growth remains unclear. OBJECTIVE: To investigate the association of proximity to the Salton Sea and dust exposure with children's lung function growth trajectories. DESIGN, SETTING, AND PARTICIPANTS: For this longitudinal cohort study, community-engaged research was conducted in Imperial Valley, California, in partnership with Comité Civico del Valle, a long-standing local community organization. Children in first to third grades from 5 elementary schools near the Salton Sea were invited to participate between May 1, 2017, and May 27, 2019.