The frequent-exacerbator (FE) phenotype guides COPD management, yet its year-to-year stability and the role of airway eosinophilia in FE remission are uncertain.

In a single-center prospective cohort (n = 289), patients were classified as FE (≥ 2 moderate or ≥ 1 severe exacerbation in the prior year; n = 88) or non-FE (n = 201) and followed 12 months. FE patients were labeled FE-persistent or FE-remitted at 1 year. Clinical data, spirometry, CT, fractional exhaled nitric oxide (FeNO), blood counts, and induced-sputum cytology were collected. Logistic regression identified correlates of remission; ROC/AUC with bootstrap validation and calibration assessed models.

FE prevalence was 30.4%; 58.0% of FE patients remitted. Compared with non-FE, FE had higher SE% and more eosinophilic/mixed sputum phenotypes. Within FE, remitters had better lung function and greater airway eosinophilia. Each 1% SE% increase independently predicted remission (OR 1.21, 95% CI 1.03-1.47); SE% ≥ 3% tripled the odds (OR 3.76, 95% CI 1.29-11.91). Prior severe exacerbations and CT-defined chronic bronchitis predicted persistence (ORs 0.21-0.27). Models showed good discrimination (AUC 0.785-0.799; bootstrap-corrected 0.750-0.773) and calibration (Brier 0.179).

FE status is dynamic; over half remit within a year. Airway eosinophilia-especially SE% ≥ 3%-independently associates with FE remission, while prior severe exacerbations and CT-chronic bronchitis indicate persistence. Incorporating sputum cytology with history and imaging may enable earlier re-stratification and treatable-trait-guided COPD care.

The limited sensitivity of conventional lateral flow assay (LFA) restricts its application in detecting trace targets. Although nanozyme-based LFAs could enhance detection performance significantly, they typically introduce additional steps, including the mixing and addition of the substrate for incubation, complicating the assay procedure. To circumvents this, we developed a hydrogel-integrated LFA platform (HG-LFA) by incorporating a sodium alginate (NaAlg) hydrogel network on a glass fiber membrane for encapsulating the chromogenic substrate 3,3'-diaminobenzidine (DAB). This three-dimensional network enables controllable release of DAB, automatically enhancing signal amplification with low background interference. Using SARS-CoV-2 E nucleic acid as a model target, the assay achieved a LOD of 0.146 nM, representing a 25-fold improvement over conventional Au@PtNPs-based LFA without signal amplification. After DAB catalysis, the signal enhancement of the HG-LFA that automatically releases the chromogenic substrate was comparable to that achieved by manual addition. In addition, the HG-LFA platform demonstrated high accuracy and stability in the detection of the target compound in biological matrix, offering a facile strategy well-suited for point-of-care testing (POCT) with high performance.

This umbrella review systematically examines pharmacological strategies for exercise-induced bronchospasm (EIB), characterized by a transient airway narrowing post-exercise, often diagnosed by a ≥ 10% reduction in forced expiratory volume in 1 s. EIB is prevalent among elite athletes and individuals exposed to environmental triggers such as cold air and pollutants. Analyzing data from 10 systematic reviews, including 8 meta-analyses, evidence confirms the efficacy of treatments including β₂-adrenoceptor (AR) agonists, muscarinic antagonists, inhaled corticosteroids (ICS), leukotriene receptor antagonists (LTRA), and mast-cell stabilizers. β₂-AR agonists demonstrate significant protective effects despite concerns regarding long-term use, while combination therapies with ICS and LTRA provide additional benefits. A key proposal is the terminological distinction between EIB and "Exercise-Induced Asthma ATtack" (EIAAT), advocating for the use of EIAAT to identify asthma exacerbations during exercise in asthmatics and EIB characterized by bronchospasm in non-asthmatics, thus avoiding misdiagnosis in athletes and guiding appropriate management. The review highlights the promising role of ICS/formoterol in pre-exercise, as-needed, and Single Maintenance and Reliever Therapy (SMART) regimens, emphasizing the need for randomized controlled trials in athletes with EIB and EIAAT. Ensuring appropriate therapy access while maintaining integrity in competitive sports is pivotal, especially with evolving pharmacological options and anti-doping regulations.

Long COVID increases healthcare utilization, yet differences in healthcare spending patterns between individuals with and without long COVID remain poorly characterized, especially at the national level. To evaluate differences in healthcare expenditures among U.S. adults with and without long COVID using nationally representative data. This cross-sectional study analyzed data from the 2022 Medical Expenditure Panel Survey (MEPS), including 16 762 unweighted adults (weighted population: 239 915 159). Healthcare spending outcomes included total expenditures and specific categories including office-based care, outpatient services, emergency room visits, hospital admissions, home healthcare, and prescription medications. A survey-weighted generalized linear model (GLM) with a log link and gamma distribution was used to estimate adjusted differences in expenditures between groups. Individuals with long COVID had significantly higher total healthcare expenditures (mean $11 567; SD $25 334) compared to those without long COVID ($7448; SD $21 734, P < .01). After adjusting for demographic characteristics, insurance status, chronic conditions, and other potential confounders, individuals with long COVID incurred 40% higher total expenditures (β = 1.40, P = .01). Expenditures were significantly elevated for office-based visits (35% higher; β = 1.35, P = .02) and outpatient services (118% higher; β = 2.18, P < .01). No significant differences were found in emergency room, hospital admissions, or dental care expenditures. Long COVID imposes a substantial financial burden on individuals and healthcare systems, primarily through increased outpatient and office-based service utilization. Understanding these spending patterns can help inform policy decisions, optimize healthcare resource allocation, and guide targeted interventions to manage long COVID more effectively.

Inflammation significantly impacts disease progression and prognosis in acute pulmonary embolism (APE); however, the optimal method to quantify this inflammation for prognostic purposes remains unclear.

We aimed to identify the most effective blood-based inflammatory marker for predicting short-term mortality in patients with APE.

We retrospectively analyzed 301 patients with APE. We compared the predictive performance of nine inflammatory markers for 30-day mortality, focusing on the inflammatory burden index (IBI), and contrasted it with the standard clinical score (sPESI).

After adjusting for potential confounders, a higher IBI was strongly and independently associated with an increased risk of 30-day mortality. IBI demonstrated superior predictive ability compared with all other inflammatory markers and the sPESI score. The relationship between IBI and mortality risk was linear; higher IBI values corresponded to greater mortality risk.

IBI is a robust and independent predictor of short-term survival in patients with APE. Calculated from routine blood tests (C-reactive protein, neutrophil, and lymphocyte counts), it offers a simple, rapid, and cost-effective tool that may enhance early risk stratification and guide personalized treatment decisions in clinical practice. Further validation in independent cohorts is required to confirm its prognostic utility.

Pediatric acute laryngitis and laryngeal obstruction can be severe enough to require tubes inserted into the airway and assist with breathing. Dexamethasone is commonly used to treat pediatric acute laryngitis and laryngeal obstruction, but the factors determining the need for intubation despite corticosteroid therapy remain unclear.

We aimed to determine the rate of intubation and mechanical ventilation required, identify risk factors for these needs and examine the outcomes in pediatric patients who still require intubation despite dexamethasone treatment.

A cross-sectional study at Jiangxi Children's Hospital included 160 screened patients with 150 pediatric patients with acute laryngitis and laryngeal obstruction, conducted from January 2020 to December 2024. All patients were given conventional dexamethasone treatment either orally or via IV. Patients were stratified into two groups: Those who required intubation and those who did not. Demographic variables, comorbidity factors, lab values and satisfaction with dexamethasone treatment, with additional support from nebulized epinephrine, were extracted. The variables were then determined via multiple logistic regression analysis.

Among the 160 screened patients, 30 (18.75%) required intubation. Independent risk factors for intubation despite dexamethasone treatment included female gender (OR = 4.07), comorbid pulmonary and systemic disorders (OR = 7.30), increased neutrophil-to-lymphocyte (N/L) ratio (OR = 1.167 per unit increase), and elevated IgM levels (OR = 1.221), all with P < 0.05. These factors were identified as significant predictors for the need for intubation despite steroid therapy.

Despite the widespread use of dexamethasone, the intubation rate remains high in pediatric patients with acute laryngitis and laryngeal obstruction. Identifying females, comorbidities, neutrophil-to-lymphocyte ratio and high levels of IgM as risk factors can assist healthcare professionals in arriving at an early diagnosis.

Bacterial immunostimulants, such as lysates and trained-immunity vaccines, reduce recurrent respiratory infections and modulate immunity in immunodeficient patients. However, heterogeneity of preparations and limited safety data call for standardized evaluation.

To assess the efficacy, immune effects, and clinical outcomes of bacterial immunostimulants in immunodeficient individuals.

This systematic review followed PRISMA 2020 guidelines. Searches were conducted in PubMed, Web of Science, EMBASE, and Cochrane Library, as well as in regional databases (AJOL, IMEMR, LILACS), and national databases including Chinese and Russian scientific resources. We included full-text clinical studies on bacterial lysates in immunodeficient patients. Fourteen original studies were identified. Meta-analysis was performed when ≥3 studies reported comparable quantitative outcomes.

Studies assessed bacterial immunostimulants in primary (IgA deficiency, IgG subclass deficiency, CVID, hypogammaglobulinemia) and secondary (HIV infection, nephrotic syndrome, hemodialysis patients) immunodeficiencies. OM-85 (bacterial lysate) significantly reduced acute respiratory tract infections (ARTIs) in patients with mild immunodeficiency compared to baseline (MD -3.52, 95% CI: -5.06 to -1.98) and controls (MD -1.75, 95% CI: -2.71 to -0.78), despite high heterogeneity. Immunological outcomes were inconsistent: IgA levels showed a slight, non-significant increase, while the rise in IgG concentrations was heterogeneous and not robust to sensitivity analyses. No evidence of autoimmune activation was documented.

Bacterial immunostimulants, particularly OM-85, show promise as adjuncts in the management of immunodeficiencies by reducing ARTIs and antibiotic use, and enhancing immune responses. They are well-tolerated, with no evidence of pathological immune activation. However, study heterogeneity and methodological differences limit comparability.

The frequency of false negatives in exercise provocation tests (EPTs) when evaluating exercise-induced allergic reactions on desensitization (EIARD) remains unclear. This study aimed to determine the frequency of allergic symptom induction after a negative EPT result in patients at risk of EIARD and to identify its associated factors.

This retrospective cohort study analyzed 109 patients aged 5-18 years who underwent EPTs between February 2012 and March 2023 to assess EIARD after wheat oral immunotherapy (OIT). EPT was performed in all cases after rush OIT and in high-risk cases after slow OIT. Patients with a negative/indeterminate EPT result were monitored for 1 year. Individuals who developed allergic reactions during exercise after wheat ingestion were categorized as "Event+" and were regarded as having false-negative EPT results. Patients without events were categorized as "Event-". Candidate factors between the Event+ and Event- groups were compared using nonparametric statistical tests.

Among 53 patients with negative/indeterminate EPT results, 14 (26.4%) experienced allergic symptoms during follow-up (Event+ group). Higher ω5-gliadin-specific IgE levels at the time of EPT were significantly associated with Event+. No other factors (i.e., age, sex, allergy severity, or exercise intensity) showed any association. All Event+ cases occurred outdoors, suggesting a possible influence of environmental factors.

False negatives occurred in 26.4% of pediatric wheat-desensitized patients with EPTs. Our findings highlight the need to periodically monitor EIARD after negative EPT results. Future studies should explore methods to improve the accuracy of EPTs and identify predictive markers of EIARD risk.

Therapeutic advancements utilizing modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) have revolutionized the treatment of people with cystic fibrosis (pwCF). Elexacaftor-Tezacaftor-Ivacaftor (ETI) is a highly effective modulator therapy and has been shown to improve health outcomes in people with CF (PwCF). Due to these therapeutic advancements, many pwCF are getting older, but little is known regarding the safety and efficacy of ETI in pwCF at a more advanced age.

We aimed to determine the effect of ETI on clinical outcomes in older pwCF.

This study was a single-center, retrospective analysis of pwCF who received open-label ETI following FDA approval and were over the age of 40 at the time of ETI initiation.

Data were obtained from the electronic medical record from a large CF center in the United States of America between November 2019 and January 2021, including body mass index (BMI), lung function as % predicted FEV₁ before ETI initiation, and approximately 3 months and one a follow-up visit within 9-15 months post-ETI initiation. The exacerbation frequency over 12 months was recorded before and after ETI initiation.

Forty-two patients met the inclusion criteria. Mean age at time of ETI initiation was 47.9, 23 patients (54.8%) were male, and 11 (26.2%) were homozygous for the F508del mutation. Linear mixed effects models suggest a monthly increase of 0.24 (95% CI 0.08-0.41, p = 0.003) for ppFEV1 and 0.03 (95% CI 0.002-0.06, p = 0.036) for BMI post-ETI, resulting in a 2.96 (95% CI 0.98-4.95) increase in ppFEV1 and 0.39 (95% CI 0.03-0.76) increase in BMI approximately 1-year post-ETI. In addition, a significant decline in pulmonary exacerbations was seen in the year following ETI initiation (1.5 ± 1.3 exacerbations/year prior vs 0.5 ± 0.7 exacerbations/year post; p < 0.0001).

Treatment with ETI in this unique cohort of pwCF was safe. Whereas ETI affected BMI in a subtle way, initiation of ETI was associated with stabilization of lung disease with a significant but moderate increase in lung function and a decline in the number of exacerbations in the follow-up period. Longer and larger studies will be needed to analyze the effect of ETI on an aging CF population.

Obstructive sleep apnea (OSA) is common and strongly linked with systemic hypertension, including resistant and nocturnal forms. Traditional OSA therapies lead to modest blood pressure (BP) reductions, but optimal antihypertensive strategies in this population remain unclear. This review examines OSA driven hypertension mechanisms, differential responses to standard OSA therapies, and evaluates evidence for mineralocorticoid-targeted treatment - including blockade of aldosterone - as a tailored BP lowering and airway improving strategy.

OSA promotes hypertension via intermittent hypoxia, sympathetic overactivity, sleep fragmentation, renin-angiotensin-aldosterone system (RAAS)-mediated fluid retention, and nocturnal fluid shifts that increase airway collapsibility. While continuous positive airway pressure (CPAP), oral appliances, weight loss, and other standard OSA therapies consistently yield modest BP reductions (typically 2-5 mmHg), patients with resistant hypertension, obesity, or high CPAP adherence derive greater benefit. Recent clinical studies demonstrate that mineralocorticoid receptor antagonists (MRAs) such as spironolactone or eplerenone reduce both apnea-hypopnea index (AHI) and BP in OSA patients with resistant hypertension. Emerging data from trials of selective aldosterone synthase inhibitors (ASIs) support meaningful BP reduction in obese hypertensive individuals with data on OSA specific outcomes remain forthcoming.