Response to biologics along a gradient of T2 involvement in patients with severe asthma: a data-driven biomarker clustering approach.

Background: Asthma with low levels of T2-biomarkers is poorly understood.

Objective: To characterize severe asthma phenotypes and compare pre- to post-biologic change in asthma outcomes along a gradient of T2-involvement.

Methods: This was a registry-based, cohort study including data from 24 countries.

Biomarker profile and disease burden associated with intermittent and long-term oral corticosteroid use in patients with severe asthma prior to biologic initiation in real-life (STAR).

Background: Asthma characterization using blood eosinophil count (BEC) (among other biomarkers and clinical indices) is recommended in severe asthma (SA), but the masking effect of oral corticosteroids (OCS), makes this challenging.

Aim: Our aim was to explore the effect of OCS use (both intermittent [iOCS] and long-term [LTOCS]) prior to biologic initiation on SA phenotype and biomarker profile in real-life and to characterize the burden of SA among patients prescribed LTOCS by biomarker profile.

Methods: This was a registry-based cohort study, including data from 23 countries collected between 2003 and 2023 and shared with the Internatonal Severe Asthma Registry (ISAR).

Comparative analysis of pulmonary function decline in patients undergoing bronchoscopic lung volume reduction with endobronchial valves versus conservative treatment in emphysema management: A longitudinal coarsened exact matched analysis.

BackgroundChronic obstructive pulmonary disease (COPD) and emphysema display a chronic and progressive disease for the individual patient. The forced expiratory volume in one second (FEV) is declining with age as displayed in the Fletcher-Peto curve. Despite established benefits of bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs), long-term data suggest a gradual reduction in the magnitude of these benefits.

Which people with severe asthma attend pulmonary rehabilitation? Insights from the German Asthma Net.

https://bit.ly/4fjzoo1.

Recurrent pulmonary alveolar proteinosis after lung transplantation: a case series.

Pulmonary alveolar proteinosis (PAP) is a rare lung disorder that is characterized by the accumulation of proteinaceous material in the alveoli, leading to dyspnea, pulmonary fibrosis and potentially death. Lung transplantation represents the ultimate treatment option in patients with end-stage or refractory PAP. So far, post-transplant recurrence of PAP has been reported in only three individual cases worldwide.

Feasibility of a Modified Bronchoscopic Transparenchymal Nodule Access Technique ('Essen Tunnel') for Improving the Diagnosis of Intraparenchymal Pulmonary Lesions.

Background And Objective: Diagnosing intraparenchymal pulmonary lesions lacking a bronchus sign remains challenging. Bronchoscopic transparenchymal nodule access (BTPNA) for reaching such lesions has seen limited clinical adoption due to insufficient evidence and practical challenges. This study evaluates the feasibility and diagnostic yield of a modified BTPNA (mBTPNA) technique-referred to as the 'Essen tunnel'-which eliminates the need for a guide sheath.

[Transition in patients with cystic fibrosis and asthma].

Adolescence represents a period of significant transformation for individuals with chronic conditions such as cystic fibrosis (CF) and asthma. Due to substantial progress in highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy, nearly everyone with CF now reaches adulthood, necessitating ongoing interdisciplinary medical care. Conversely, approximately 70% of children with asthma experience a resolution of symptoms as they reach adulthood.

Disease Burden of RSV Infection in Adult Patients in Comparison to Influenza Virus Infection.

Respiratory Syncytial Virus (RSV) is well known for its impact on children, but its burden in adults remains underexplored, partly due to limited PCR testing before the COVID-19 pandemic. In this study, the medical burden of RSV infections in adults was retrospectively investigated using 6-year longitudinal data from a university hospital in North Rhine-Westphalia, Germany. Outcomes of 380 PCR-confirmed RSV cases were compared with 1088 influenza A/B cases from 2018 to 2023, stratified by age groups ( < 60 and ≥ 60 years).

Type 2 inflammation, a common denominator in chronic airway disease?

Purpose Of Review: This review addresses the growing understanding that a specific subset of patients with a respiratory disease, including asthma, chronic obstructive pulmonary disease (COPD), or bronchiectasis may have one thing in common: type 2 inflammation. In the era of personalized medicine, we need to refine clinical markers combined with molecular and cellular endotyping to improve patient outcomes.

Recent Findings: Recent literature reveals that type 2 markers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), and immunglobulin E (IgE), can provide valuable insights into disease progression, exacerbation risk, and treatment response, but their stability remains to be investigated.

German Asthma Net: Characterisation of responders to anti-IL-5 and anti-IL-5(R) therapy.

Introduction: Previous studies of anti-IL-5/IL-5(R) therapies in severe asthma found that response was mainly predicted by indicators of good baseline disease control. However, long-term response predictors remain unclear.

Methods: Responders to anti-IL-5/IL-5(R) therapy in the well-characterised, real-life, international German Asthma Net (GAN) registry were analysed using regression analyses.

First assessment of photon-counting CT for virtual bronchoscopic navigation.

https://bit.ly/3BXQ3zj

International Severe Asthma Registry (ISAR): 2017-2024 Status and Progress Update.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research.

The Impact of Smoking History on Baseline Characteristic in Patients With Severe Asthma in the German Asthma Net (GAN).

Background: Patients with asthma with >10 pack-years are frequently excluded from asthma trials. Little is known about how smoking affects their characteristics and therefore may impact treatment choices.

Objective: To evaluate the impact of cumulative smoking history on the characteristics of patients with severe asthma.

Roads to remission: evolving treatment concepts in type 2 inflammatory diseases.

Unlabelled: Non-communicable diseases (NCDs) characterised by type 2 inflammation, including asthma, allergic rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis, food allergies and eosinophilic esophagitis, are increasing in prevalence worldwide. Currently, there is a major paradigm shift in the management of these diseases, towards the concept of disease modification and the treatment goal remission, regardless of severity and age. Remission as a treatment goal in chronic inflammatory NCDs was first introduced in rheumatoid arthritis, and then adopted in other non-type 2 inflammatory diseases.

Impact of Smoking on Biological Treatment Response in Patients From the German Severe Asthma (GAN) Registry.

Background: Clinical studies of biologics in severe asthma exclude smokers or ex-smokers (ExS) with over 10 pack-years (py). Thus, the effectiveness of this therapy in ExS with severe asthma is not well understood.

Objectives: To assess the impact of smoking on clinical efficiency of biologics in patients with severe asthma from the German Asthma Net, a comprehensive international registry.

Sex Differences in Sleep Profiles and the Effect of Elexacaftor/Tezacaftor/Ivacaftor on Sleep Quality in Adult People with Cystic Fibrosis: A Prospective Observational Study.

Background/objectives: Recent studies indicate that sleep and sleep disorders differ between men and women, but corresponding data in people with chronic lung diseases are lacking. This study aims to answer the question of what the sex-specific differences in sleep profiles and responses to elexacaftor/tezacaftor/ivacaftor (ETI) therapy in people with cystic fibrosis (pwCF) are.

Methods: Adult pwCF and a matched control group (adults with suspected sleep-disordered breathing undergoing in-laboratory polysomnography (PSG)) were included.

Bronchoscopic biopsies - a novel source for primary airway epithelial cells in respiratory research.

Background: Using primary airway epithelial cells (AEC) is essential to mimic more closely different types and stages of lung disease in humans while reducing or even replacing animal experiments. Access to lung tissue remains limited because these samples are generally obtained from patients who undergo lung transplantation for end-stage lung disease or thoracic surgery for (mostly) lung cancer. We investigated whether forceps or cryo biopsies are a viable alternative source of AEC compared to the conventional technique.

Fully automatic quantification of pulmonary fat attenuation volume by CT: an exploratory pilot study.

Background: Non-malignant chronic diseases remain a major public health concern. Given the alterations in lipid metabolism and deposition in the lung and its association with fibrotic interstitial lung disease (fILD) and chronic obstructive pulmonary disease (COPD), this study aimed to detect those alterations using computed tomography (CT)-based analysis of pulmonary fat attenuation volume (CTpfav).

Methods: This observational retrospective single-center study involved 716 chest CT scans from three subcohorts: control (n = 279), COPD (n = 283), and fILD (n = 154).

[Recommendations on interpretive strategies for routine lung function tests].

During the annual conference of the German Respiratory Society (DGP = Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin) in 2024, updated recommendations for lung function testing have been published. The original full-length version can be downloaded free of charge as pfd-paper from the journal entitled "Atemwegs- und Lungenkrankheiten, Jahrgang 50 (2024) März (111-184)". In the current recommendations new approaches have been embedded that focus on modern interpretations of lung function results, as has been proposed by the ERS (European Respiratory Society) in collaboration with the ATS (American Thoracic Society).

Functional characterization of OR51B5 and OR1G1 in human lung epithelial cells as potential drug targets for non-type 2 lung diseases.

Background: Hypersensitivity to odorants like perfumes can induce or promote asthma with non-type 2 inflammation for which therapeutic options are limited. Cell death of primary bronchial epithelial cells (PBECs) and the release of the pro-inflammatory cytokines interleukin-6 (IL-6) and IL-8 are key in the pathogenesis. Extra-nasal olfactory receptors (ORs) can influence cellular processes involved in asthma.

Opportunistic Screening for Low Bone Mineral Density in Adults with Cystic Fibrosis Using Low-Dose Computed Tomography of the Chest with Artificial Intelligence.

Cystic fibrosis bone disease (CFBD) is a common comorbidity in adult people with cystic fibrosis (pwCF), resulting in an increased risk of bone fractures. This study evaluated the capacity of artificial intelligence (AI)-assisted low-dose chest CT (LDCT) opportunistic screening for detecting low bone mineral density (BMD) in adult pwCF. In this retrospective single-center study, 65 adult pwCF (mean age 30.

Adult patients with severe respiratory syncytial virus infections in the emergency department.

Respiratory syncytial virus (RSV) is a seasonal virus known to cause significant morbidity in pediatric patients; however, morbidity in adult patients has not been well investigated. We aimed to characterize adult patients with RSV infection in the emergency department (ED) and their clinical course. During the winter term 2022/23, all adult ED patients were screened for RSV, severe acute respiratory syndrome coronavirus type 2, and influenza infection using point-of-care polymerase chain reaction tests.