Ageing significantly impacts lung function and increases susceptibility to chronic lung diseases. The lung is a complex organ with multiple cell types that undergo cellular age-related perturbations or hallmarks. As knowledge of ageing mechanisms has progressed, we have a better understanding how intracellular adaptations impact cellular crosstalk and integrate to increase the susceptibility to age-related diseases in the lung. Herein, we discuss the prospects of exhaustion of lung progenitor cells, disrupted lung cell plasticity, perturbation in fibroblasts, impaired adaptive immune responses and alterations in lung microenvironment in the promotion of ageing and age-related lung diseases. Additionally, the ageing process trajectory of the lung depends on a combination of biological, genetic, metabolic, biomechanical and sociobehavioural factors that range from protective phenotypes to accelerated ageing phenotypes. We propose the concept of AgEnOmics, which expands the temporal dimension of lung ageing by distinguishing between chronological ageing and accelerated lung ageing phenotypes. Based on this concept, we define biomarkers of biological ageing that will help to define accelerated ageing and early interventions in biological ageing-related lung diseases.

Dyspnoea affects 10% of the general population, and 12% of hospitalised patients report experiencing dyspnoea at rest. It is a common and distressing symptom experienced by people living with chronic obstructive pulmonary disease (COPD). Neuromodulation, which uses electrical stimulation to modulate neural pathways, is a validated clinical procedure offering a potential therapeutic approach. We speculate that non-invasive transcutaneous vagus nerve stimulation (tVNS) and trigeminal transcutaneous electric nerve stimulation (TENS) could improve dyspnoea management by targeting relevant neural circuits.

We will conduct a feasibility cross-over trial in people with severe COPD and significant exertional dyspnoea referred for pulmonary rehabilitation. Patients will be recruited following the prerehabilitation assessment visit comprising a clinical evaluation and a maximal cardiopulmonary exercise testing on ergocycle. Subsequently, two study visits will be conducted within 2 weeks apart from each other. Eight participants will perform a submaximal constant work rate at 80% workload of the VO₂ max, either with cervical tVNS (n=4) or trigeminal TENS (n=4). In a cross-over design, both patient groups will undergo sham and active treatment of the neuromodulation technique in a randomly assigned order. The main outcome will be feasibility, assessed by the percentage of patients who attend all visits and complete all tests. Secondary outcomes include other feasibility endpoints, the acceptability and suitability of the interventions (including an evaluation of sham as an exploratory outcome), and the incidence of adverse or undesirable events related to the procedures. Exploratory outcomes include changes in dyspnoea symptoms, measured using standardised questionnaires, such as Borg scale and the Visual Analogue Scale.

The protocol is approved by the institutional research ethics committee of the Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie-CHUS, Sherbrooke, Quebec, Canada (#2025-5604) and follows 2013 Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Results will be communicated in international meetings and submitted to peer-reviewed journals with respect to the 2010 CONsolidated Standards Of Reporting Trials (CONSORT) statement for feasibility studies.

NCT06985628.

COVID-19 vaccine distribution was marked by deeply unequal access for Africa, Asia, and Latin America. This article analyzes negotiations between government and pharmaceutical companies, through the case of South Africa, to better understand the mechanisms through which the international order produced this inequality. A process we label policymaking via contract undermined state power during the pandemic. Using a unique archive of unredacted contracts and negotiation documents obtained through court order, our analysis shows that, given limited supply, monopolised production, and fragmented global governance, companies exercised exceptional power and made allocations between countries. South African officials objected, but eventually acceded, to 'unacceptable' provisions requiring large payments without binding commitments on volume or delivery timing and little recourse for non-delivery. This helps explain South Africa's delayed vaccine roll-out. New policy was made via contract on vaccine indemnification, intellectual property, and export controls. Secrecy provisions particularly disempowered government. In future pandemics, power dynamics revealed in these negotiations call into question whether voluntary mechanisms for allocating medical countermeasures globally can ever achieve equity. Instead of focusing on funding pooled procurement, global health actors should make greater use of international law, technology transfer, and cooperation on contract transparency to shift dynamics and empower states.

Influenza poses a major health challenge due to its variability and pandemic potential, making prevention crucial. The study aimed to explore the link between influenza vaccination and complementary and alternative medicine (CAM) practices among Palestinian adults, along with factors influencing vaccination rates. It also evaluated participants' attitudes towards CAM and beliefs regarding herbal and vitamin use for influenza management.

A cross-sectional study was carried out between 18/02/2024 and 23/04/2024, during which a self-administered online questionnaire was shared through social media and personal communication. This questionnaire was aimed at all adults aged 18 and above. Both descriptive and regression analyses were performed.

The study included 363 participants, revealing an influenza vaccination rate of only 9%. A significant correlation was found between manipulative, body-based methods, mind-body medicine, and vaccination status (P-value<0.05), while no significant relationship was noted with herbal remedies or alternative medical systems. Higher income and better health status were linked to increased vaccination likelihood (P-value<0.05), indicating a need for targeted public health campaigns. Although 63% of participants were familiar with complementary and alternative medicine (CAM), 34% had never used it for influenza, highlighting a knowledge gap. Popular natural remedies like Vitamin C, ginger, and honey reflect a trend toward preventive healthcare despite concerns over costs and skepticism about CAM's effectiveness.

Vaccine hesitancy is influenced by multiple factors, including context and types of CAM use. Cultural beliefs and personal health philosophies significantly shape attitudes toward CAM use and vaccination.

Noninvasive ventilation (NIV) is a cornerstone in the management of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). The aim of this study is to assess the impact of music-based intervention on the efficiency of NIV in patients with AECOPD.

It's a prospective, randomized, single-blinded, parallel-group trial. Critically ill COPD patients admitted for acute exacerbation and eligible for NIV will be included. Patients in the control group will receive only NIV. In the intervention group, patients will receive NIV with music-based intervention. The music will be delivered through headphones. Both groups will receive standard care in accordance with current clinical guidelines. The primary endpoint is the change in arterial Pressure of Carbon dioxide PaCO2, defined as the difference between baseline PaCO₂ (prior to NIV initiation) and PaCO₂ measured after 4 hours. Secondary endpoints will be recorded at different time points: change of PaCO2 over time (h0, h2, h4), unplanned interventions, changes in respiratory and cardiovascular parameters (h0, h2, h4), changes in Respiratory comfort (h0, h2, h4), Borg Dyspnea Scale (h0, h2, h4), Verbal Numeric Rating Scale for pain assessment (h0, h2, h4), Encephalopathy score (h0, h2, h4), Richmond Agitation-Sedation Scale (h0, h2, h4), and psychological assessment (Rapid Clinical Test For delirium, State Trait Anxiety Inventory, perceived stress scale) (h0, h4).

This study is expected to contribute reliable scientific evidence for the optimal management of AECOPD, potentially reducing the need for intubation and mechanical ventilation and their associated complications.

The study was prospectively registered on the Pan African Clinical Trial Registry within the number PACTR202501862862010.

While most research on Long COVID (LC) has focused on symptoms and quality of life, there remains a critical need to better understand the effect of LC on resource utilization. This study sought to determine the type and amount of healthcare utilization among participants with versus without LC.

This was a secondary analysis of a prospective, longitudinal, multicenter U.S. study of adult participants with symptomatic COVID-19, confirmed with testing, who completed 3-month post-infection surveys and had electronic health record data for at least 180 days pre- and post-index testing. We excluded participants with any COVID-19 infections within the 6 months following enrollment. Consistent with prior work, LC was defined as ≥3 post-infectious symptoms at 3 months, while those with <3 symptoms were categorized as not having LC. Our primary outcome was to compare the change in visit types between pre- and post-index testing (hospitalization, emergency department visit, office visit, procedure, telehealth, and other). As secondary outcomes, we assessed differences in visit complexity using the summative length of each encounter for each category as a measure of total healthcare usage.

A total of 847 participants met inclusion criteria (179 LC, 668 non-LC). When compared with the pre-index period, there was an overall increase in visit numbers of all six visit categories during the post-index period for all groups, most pronounced in office and telehealth visits. When compared with the non-LC group, the LC group was less likely to have ED visits (OR: 0.1; 95% CI 0.0-0.5). However, among those with LC who had at least one hospitalization, they were more likely to have additional hospitalizations (OR: 2.6; 95% CI 1.5-4.6). Visit length for office visits and hospitalization in the LC group was increased when compared with the non-LC group, though this diminished after adjustment for patient baseline characteristics.

All participants who were infected with SARS-CoV-2 had a marked increase in healthcare utilization during the subsequent 180 days. The LC group had significantly higher rates of additional hospitalization compared with those without LC, which may help to inform healthcare resource planning.

In India, there is no information on health related quality of life (HRQoL) of patients with drug sensitive tuberculosis (TB) using a longitudinal design that includes post- treatment period. This study is the first of its kind in India to assess HRQoL of TB patients from a longitudinal prospective and to identify the factors associated with changes in HRQoL.

The study participants were 180 newly diagnosed drug-sensitive smear-positive pulmonary TB patients who were initiated on treatment under the National TB Elimination Programme (NTEP) in Chennai and Tiruvallur districts of Tamil Nadu, South India. The patients were interviewed at four different time points between 2020 and 2023 using validated questionnaires assessing general health (European Quality of Life-5 Dimensions-5 Level (EQ-5D-5L), Short Form health survey (SF-20)), disease specific (St. George's Respiratory Questionnaire (SGRQ)) and mental health including depression and anxiety (Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7)). The Friedman test was used to identify changes in HRQoL scores over time and generalised estimating equation (GEE) were applied to identify factors associated with HRQoL.

HRQoL scores of TB patients, as measured by different scales showed significant improvement from treatment initiation to treatment completion. The GEE analysis showed that the EQ-5D-5L scores over follow-up visits were significantly lower in females (-0.038, p < 0.005) and higher in those who did not skip their main meal in a day (0.077, p < 0.001). The PHQ-9 and GAD-7 scores were significantly higher among females (0.609, p < 0.05; 0.531, p < 0.05). Additionally, PHQ-9 scores were also higher among patients from rural district (0.392, p < 0.05). The SF-20 scores were significantly lower in patients aged >45 years (-1.675, p < 0.05), female (-3.809, p < 0.001) and unemployed (-2.277, p < 0.005). The SGRQ scores were higher in patients aged >45 years (3.043, p < 0.01), females (4.256, p < 0.05) and those from rural district (2.219, p < 0.05). The HRQoL scores were significantly higher in patients who did not skip their main meal and lower in females irrespective of the scales used.

The HRQoL of TB patients improved significantly over a period of treatment. Gender, age, skipping main meals, region and employment status were the key factors influencing HRQoL. Focusing on HRQoL assessment in the care of TB patients could help to minimize physical, mental and social challenges and enable them to lead a normal life.

Nonpharmaceutical interventions (NPIs) such as mask-wearing and social distancing during the COVID-19 pandemic significantly reduced the transmission of common respiratory viruses, including influenza virus and respiratory syncytial virus (RSV). As NPIs were stopped, concerns emerged about "immunity debt," which suggests that limited natural exposure to pathogens may have increased susceptibility and severity, particularly among young children. However, despite growing attention, the postpandemic impact of NPIs on epidemiologic patterns and shifts in age-specific disease burden remains underexplored.

This study aims to investigate, using national surveillance data, the repercussions of the COVID-19 pandemic on the epidemiology and clinical burden of influenza virus and RSV infections in Korea, with an emphasis on the influence of NPIs on the incidence and clinical severity of these infections, particularly among young children.

We analyzed weekly virologic, outpatient, and inpatient surveillance data on influenza virus and RSV infections from the Korea Disease Control and Prevention Agency from 2017 to 2024, covering the prepandemic, pandemic, and postpandemic periods. Time-series analyses were conducted to examine changes in seasonality and to estimate age-specific incidence and clinical severity of influenza virus and RSV infections before and after the COVID-19 pandemic.

In the postpandemic seasons, both RSV and influenza virus infections showed disrupted seasonality with delayed and prolonged epidemics. While the overall burden of both viruses was comparable to that for prepandemic periods, there was a notable shift in the age distribution of severe cases. Among influenza-associated hospital admissions, the proportion of school-aged children (7-18 years) doubled, rising from 14% (1,814/12,660) in 2019/20 to 28% (2,176/7,755) in 2022/23. Hospitalization rates in this age group also increased significantly, from 46.8 to 64.4 per 100,000 among children aged 7-12 years, and from 16.4 to 30.0 per 100,000 among those aged 13-18 years. For RSV infections, the burden shifted most prominently to young children aged 1-6 years, whose share of hospital admissions rose from 48% (5,789/11,969) to 61% (7,316/12,011) over the same period. This age group also experienced the largest rise in RSV-associated hospitalization rates, increasing from 230.8 to 357.5 per 100,000 between the 2019/20 and 2022/23 seasons.

The patterns of influenza virus and RSV infections in Korea following the COVID-19 pandemic reveal distinct shifts in timing, severity, and the age groups that were most affected. Postpandemic influenza and RSV activity in Korea showed delayed and prolonged epidemics, with shifts in age-specific disease burden rather than an overall increase. Substantial increases in susceptibility and severity among young children for RSV infections and older children for influenza virus infections suggest lingering immunity gaps from reduced exposures during the pandemic. These effects may be further compounded by declining influenza vaccine uptake among children following the pandemic. Our findings underscore the importance of ongoing surveillance and targeted public health measures to manage respiratory viruses in the postpandemic era.

Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: A prospective study was conducted in asymptomatic or mild COVID-19 patients with normal chest radiographs at two medical centers in Thailand. Spirometry data, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory flow at 25-75% of FVC (FEF25-75), and bronchodilator responsiveness (BDR), were collected. Spirometry was performed after disease resolution at baseline and 3-month follow-up. Abnormal lung functions were classified into airway obstruction, restrictive defect, mixed defect, small airway disease, and BDR. Results: A total of 250 patients (58% female) were included. The mean age was 37.4 ± 15.2 years. Asymptomatic patients accounted for 7.6%. Common symptoms included fever (55.6%) and cough (60.0%). Abnormal lung functions were observed in 28.4% of patients, with a restrictive lung pattern (14.4%), airway obstruction (4.8%), mixed defect (0.4%), small airway disease (8.4%), and BDR (2.8%). Significant changes from baseline were noted in FVC (1.21%), FEV₁/FVC (-1.51%predicted), PEF (0.06%), and FEF_25-75 (-2.76%). Logistic regression analysis indicated that a higher body mass index was associated with a lower risk of abnormal lung function. Conclusions: Ventilatory defects were observed in one-third of patients with mild COVID-19 who did not require hospitalization, mainly presenting as restrictive patterns and small airway disease. Even mild cases may have residual pulmonary impairment, warranting further long-term studies.

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.

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.

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).

IOS demonstrated better diagnostic ability for detecting uncontrolled asthma than spirometry.