Type 2 (T2) biologics represent a promising treatment option for chronic obstructive pulmonary disease (COPD) patients with eosinophilic inflammation.

To evaluate the prevalence of stable COPD patients who may be eligible for T2 biologics.

Real-world, retrospective, monocentric study in COPD patients undergoing inpatient pulmonary rehabilitation.

Clinical, functional, and inflammatory data were collected. Patients were considered eligible for T2 biologic therapy whether they were receiving optimized inhaled therapy and had a history of ⩾2 moderate and/or ⩾1 severe exacerbations in the previous year, together with a blood eosinophil count ⩾300 cells/μL.

Among 441 patients, 21.5% had blood eosinophil counts ⩾300 cells/μL and 6.8% fulfilled the combined eligibility criteria. A high burden of respiratory and cardiometabolic comorbidities and increased cardiovascular risk was observed in the overall population.

Only a subgroup of patients seems eligible for biologics, treatment escalation should be based on optimized standard care management and patient phenotyping.

Environmental fungi play an important role in allergic respiratory diseases. Alternaria alternata sensitization has been associated with more severe respiratory phenotypes and poorer asthma control. Mediterranean agricultural environments may favor environmental exposure because of their climatic conditions and intensive agricultural activity.

To analyze the prevalence of sensitization to Alternaria alternata, evaluate its association with asthma control and quality of life, and describe household environmental findings in a Mediterranean agricultural population.

An observational, analytical, cross-sectional study with standardized collection of clinical, allergological, and environmental data was conducted in 100 consecutive adult patients (18-65 years) with allergic rhinitis/rhinoconjunctivitis, with or without associated asthma. Sensitization to Alternaria alternata was defined by a positive skin prick test and/or molecular determination against Alt a 1 (>0.35 kUA/L). Asthma control was assessed using the Asthma Control Test (ACT), quality of life using the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), and rhinitis control using the Spanish Rhinitis Questionnaire (SPRINT). Household environmental evaluation was performed in sensitized patients.

Sensitization to Alternaria alternata was observed in 29% of patients (95% CI: 20.1-38.8). Skin prick testing was positive in 25 patients, whereas molecular sensitization against Alt a 1 was observed in 20 patients. Sensitized patients showed poorer asthma control and greater quality-of-life impairment than non-sensitized patients. No significant differences in the polysensitization burden were observed. Among sensitized patients, household microbiological assessment demonstrated Alternaria alternata detection in 46.4% of indoor samples and 28.6% of outdoor samples.

Sensitization to Alternaria alternata was frequent in this Mediterranean agricultural population and was associated with poorer asthma control and greater quality-of-life impairment. Environmental findings support further investigation of fungal exposure in Mediterranean agricultural settings.

The relationship between blood eosinophilia and length of hospital stay has been scarcely analyzed.

To establish the prevalence of eosinophilia in children with asthma exacerbation and to evaluate its association as a predictor of the length of hospital stay in these patients.

This retrospective cohort study analyzed data from children aged 2 to 17 years who were hospitalized for asthma exacerbation between January 2019 and December 2024 at teaching hospital. Multivariate analyses were performed to evaluate the association between blood eosinophilia (≥ 500 cells/µL) and length of hospital stay (≥ 4 days).

Data from 225 children were analyzed; 15.1% had eosinophilia (exposed group), while the remaining 84.9% did not (non-exposed group). In the absence of pneumonia, the eosinophilia group was less likely to experience a prolonged hospital stay (RR = 0.6, P = 0.034). In this same group, eosinophils ≥ 500 cells/µL reduced the likelihood of a hospital stay ≥ 4 days (adjusted OR 0.22, P = 0.005) in the multivariate analysis. Meanwhile, age ≥ 6 years (adjusted OR 4.12, P < 0.001), moderate (adjusted OR 2.54, P = 0.016) and severe (adjusted OR 8.42, P = 0.003) Pulmonary Scores were predictors of prolonged hospital stay.

Blood eosinophilia ≥ 500 cells/µL is associated with a shorter hospital stay. Additionally, children aged 6 years or older and those with moderate or severe exacerbations have a higher risk of prolonged hospitalization.

Bio-Immune is a standardized extract containing andrographolide, a diterpenoid lactone derived from the aerial parts of Andrographis paniculata (commonly known as Kalmegh), and the carrier, 2-hydroxypropyl beta-cyclodextrin. Kalmegh has long been used to treat uncomplicated upper respiratory tract infection (URTI) in complementary and alternative medicine. A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy of Bio-Immune (≥ 17% w/w andrographolide content).

Participants were randomized to receive either 100 mg Bio-Immune twice daily or placebo for a 5-day intervention period (Clinical trial registration number: CTRI/2024/12/077632, Registered 4, December 2024). The primary outcome measure was the Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) score; secondary outcomes included Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) scores, nasal mucus weight, C-reactive protein (CRP), Interleukin-8 (IL-8), and Immunoglobulin A (IgA) in nasal wash, along with safety.

Of 67 screened participants, 56 were enrolled, and 55 completed the study. The WURSS-21, VAS, and NRS scores in the Bio-Immune group improved, with statistically significant reductions suggesting relief from symptoms associated with uncomplicated URTI and sustained functional improvement owing to Bio-Immune supplementation. Although the placebo group showed gradual improvement over time, the speed and magnitude of recovery were consistently and statistically superior in the Bio-Immune cohort, with significant changes evident by 6 h after supplementation. Furthermore, a significant reduction in nasal mucus weight was observed by Day 5, accompanied by minor downward trends in CRP and IL-8, which lacked adequate statistical support. No adverse events were reported during the intervention period.

Clinical findings support the efficacy of Bio-Immune at a lower dose in providing URTI symptom relief compared with placebo in a shorter intervention period.

Clinical Trial Registry of India: CTRI/2024/12/077632; ClinicalTrials.gov identifier: NCT06689995.

WHO reports that only 54% of tuberculosis (TB) patients received rapid diagnostic tests at their initial presentation. Conventional laboratory methods in TB detection have high specificity (>90%) but low sensitivity (<50%). This means a large number of tuberculosis patients are missed. A better diagnostic approach is essential to decrease the TB burden. Studies on multi-indicator blood-based models for rapid TB diagnosis remain limited. We developed a rapid, non-sputum-based model to improve the efficiency of TB diagnosis. This was a retrospective case-control study including 301 patients with active tuberculosis (ATB) and 191 patients with other pulmonary diseases (OPD) who were evaluated at the Department of Pulmonary Medicine of the Affiliated Infectious Diseases Hospital of Soochow University between May 2023 and May 2024. A composite clinical diagnosis served as the gold standard for ATB diagnosis, including either a clinical diagnosis or bacteriological confirmation. The diagnostic outcome of ATB (ATB vs OPD) was defined as the dependent variable, while guanylate-binding protein 5 (GBP5) expression levels and routine laboratory indicators (including blood cell counts and plasma protein measurements) were defined as independent variables. Univariate and multivariate logistic regression analyses were performed to identify key predictors, and an AdaBoost algorithm was used to construct a TB diagnostic model. The performance of the model was compared with traditional laboratory-based TB tests. DeLong's Test was used to evaluate the statistical difference of AUC between AdaBoost and traditional methods. Through univariate and multivariate logistic regression analyses, the GBP5 gene, white blood cell (WBC) count, platelet (PLT) count, and prothrombin time (PT) were selected to construct an ATB diagnosis model using the AdaBoost algorithm. The AdaBoost model achieved an AUC of 0.808 in the training set and 0.805 in the test set, while the AUC of smear microscopy, MTB culture, Xpert MTB/RIF, and IGRA were 0.67, 0.59, 0.63 and 0.75 respectively. Therefore, our model demonstrated better diagnostic performance than conventional methods. This study preliminarily demonstrates that our AdaBoost diagnostic model based on GBP5 gene expression and routine blood indicators could serve as a potential tool for the clinical diagnosis of ATB. However, to be applied to the clinic, large samples are needed to validate the performance of the model.

Coronavirus disease 2019 (COVID-19) has been linked to systemic immune dysregulation and various cutaneous manifestations, but its association with chronic allergic skin diseases, including atopic dermatitis (AD) and chronic urticaria (CU), remains unclear. This retrospective questionnaire-based cross-sectional study enrolled patients with AD and/or CU from a tertiary dermatology outpatient center in Western China. Self-administered questionnaires collected data on COVID-19 infection status, clinical characteristics, medication use, and self-reported changes in disease status within 14 days of COVID-19 symptom onset or diagnosis. Outcomes were self-reported rather than based on validated severity scores, and no prospective longitudinal follow-up was performed. Multivariable logistic regression analyses were conducted to identify factors associated with self-reported exacerbation. Covariates were selected a priori based on clinical relevance, and no missing data were present. A total of 509 patients with AD and/or CU were included. Compared with the non-COVID-19 group, participants with COVID-19 more frequently reported current alcohol consumption, pre-COVID-19 antihistamine use, insomnia, allergic rhinitis, and discontinuation of dermatological medications. COVID-19 infection was associated with self-reported exacerbation of allergic skin diseases in both the baseline-adjusted model (odds ratio [OR] = 4.611, 95% confidence interval [CI] = 2.268-9.377) and the fully adjusted model (OR = 4.445, 95% CI = 2.159-9.151). Among participants with COVID-19, fever, headache, fatigue, taste loss, reported use of antipyretics and antibiotics, and nervousness differed between the exacerbation and non-exacerbation groups. After multivariable adjustment, fatigue (OR = 1.601, 95% CI = 1.049-2.443), taste loss (OR = 1.654, 95% CI = 1.004-2.723), and the reported use of antibiotics (OR = 1.609, 95% CI = 1.036-2.499) and antipyretics (OR = 1.575, 95% CI = 1.037-2.392) were associated with self-reported exacerbation, although the medication-related associations likely reflected confounding by indication. Sensitivity analyses yielded consistent results. In this retrospective questionnaire-based cross-sectional study conducted during the omicron wave, COVID-19 infection was associated with self-reported exacerbation of AD and CU within 14 days of symptom onset or diagnosis. Because the outcome was based on participants' recall of symptom change rather than objective clinical assessment, the findings should be interpreted with caution, and their generalizability is limited by the single-center, omicron-period design. Associations with antipyretics and antibiotics likely reflect confounding by indication rather than direct pharmacological effects. Prospective multicenter studies with standardized outcome measures are needed to validate these findings.

Chronic obstructive pulmonary disease (COPD) is frequently complicated by cardiovascular disease (CVD), which significantly increases morbidity and mortality. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has emerged as a novel inflammatory biomarker associated with various cardiovascular conditions. However, its relationship with CVD in COPD patients remains understudied. This study aimed to investigate the association between MHR and coexisting CVD in patients with COPD. This cross-sectional investigation analyzed the National Health and Nutrition Examination Survey data from 2007 to 2018, focusing on adults aged ≥40 years with physician-diagnosed COPD. The primary outcome encompassed cardiovascular conditions including congestive heart failure, coronary heart disease, angina pectoris, or myocardial infarction. MHR was analyzed both as a continuous variable and in quartiles. Four sequential logistic regression models were applied: Model 1 was unadjusted; Model 2 adjusted for sex, age, and race/ethnicity; Model 3 further adjusted for education, marital status, smoking, and poverty-income ratio; Model 4 additionally adjusted for hypertension, diabetes, and body mass index. Dose-response relationships were assessed using restricted cubic splines. A total of 1064 COPD patients were included (mean age, 62.8 ± 10.5 years; 56.6% female), of whom 206 (19.4%) had coexisting CVD. Compared with patients without CVD, those with CVD were older (median, 68 vs 61 years; P < .001), more often male (62.1% vs 38.9%; P < .001), and had a higher prevalence of diabetes (43.2% vs 24.4%; P < .001) and hypertension (82.5% vs 54.6%; P < .001). MHR levels were higher in the CVD group than in the non-CVD group (0.542 vs 0.423; P < .001). In the fully adjusted model, each 1-unit increase in MHR was associated with higher odds of CVD (odds ratio, 3.27; 95% confidence interval, 1.59-6.74; P < .001). A graded association was observed across MHR quartiles (P for trend < .001), with the highest quartile showing greater odds of CVD than the lowest (odds ratio, 2.70; 95% confidence interval, 1.57-4.73; P < .001). Restricted cubic spline analysis indicated a nonlinear positive association between MHR and CVD. In COPD patients, higher MHR was independently associated with a greater prevalence of coexisting CVD, with a graded and nonlinear pattern. Given the cross-sectional design, causal inference is not warranted, and prospective studies are needed.

Obstructive sleep apnea (OSA) and respiratory failure (RF) represent increasing clinical and public health challenges in the United States, yet national trends in mortality remain underexplored. This study evaluates trends in mortality associated with OSA and RF to highlight targeted prevention and management across demographics and regions. Using the CDC WONDER multiple cause of death (MCD) database, we retrieved death certificates from 1999 to 2023 to analyze mortality related to OSA and RF among adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and categorized by demographics and region. Joinpoint regression was used to estimate annual percent change (APC) and average APC. A total of 71,202 deaths occurred due to OSA and RF. The AAMR observed a significant and steep incline from 0.25 in 1999 to 2.26 in 2023 (AAPC: 9.3; 95% CI: 8.04 to 10.65, P < .01). Men had higher AAMRs than women (men: 0.32; women: 0.21) in 1999 to (men: 2.79; women: 1.85) in 2023. Racially, NH Blacks demonstrated the highest increase in AAMR from 0.53 in 1999 to 2.16 in 2023.The overall AAMR remained higher in nonmetropolitan areas compared to metropolitan areas (1.23 vs 1.01). Regionally, the Midwest recorded the greatest burden with AAMR increasing from 0.21 in 1999 to 2.55 in 2023. State-level AAMRs ranged from 0.58 (New York) to 1.92 (Nebraska) in 2020. Using nationwide retrospective data from 1999 to 2023, our study revealed that adults with concomitant OSA and RF face steadily rising mortality rates, with marked differences observed across demographic groups and geographic regions in the U.S., underscoring the importance of tailored strategies such as expanding access to early detection, and ensuring equitable healthcare delivery to reduce mortality and improve outcomes among such patients, particularly in disproportionately affected populations and regions.

The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is a composite biomarker reflecting systemic inflammation and lipid metabolism. We examined associations between NHR and cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD). This cross-sectional study analyzed National Health and Nutrition Examination Survey data (2007-2018) including adults aged ≥40 years with COPD. CVD was defined as self-reported heart failure, coronary artery disease, angina, or myocardial infarction. NHR was calculated as neutrophil count (×103/μL) divided by high-density lipoprotein cholesterol (mmol/L). Multivariable logistic regression assessed NHR-CVD associations, with restricted cubic splines evaluating dose-response relationships. Among 1033 COPD patients, 199 (19.3%) had CVD. After multivariable adjustment, each unit increase in NHR was associated with higher CVD odds ratio (OR: 1.24, 95% confidence interval [CI]: 1.11-1.38). Compared to the lowest quartile, Q3 (OR: 1.65, 95% CI: 1.04-2.85) and Q4 (OR: 2.60, 95% CI: 1.52-4.52) showed higher CVD odds. Spline analysis revealed a nonlinear relationship with a potential inflection point around NHR ≈ 3.4. Associations remained consistent across subgroups. Elevated NHR is independently associated with higher CVD prevalence in COPD patients. This cross-sectional analysis suggests NHR may serve as an accessible inflammatory biomarker reflecting cardiovascular comorbidity in this population.

Chronic cough is a common reason for pediatric consultation and may lead to repeated medical visits, caregiver anxiety, inappropriate use of diagnostic tests, and unnecessary treatments. In children and adolescents, chronic cough should be regarded primarily as a symptom of an underlying condition rather than as a standalone diagnosis, requiring age-specific diagnostic pathways. In 2020, the Italian Society of Pediatric Allergy and Immunology (SIAIP) published a document on this issue.

To develop a pragmatic, algorithm-based approach for the evaluation and management of chronic cough in children and adolescents, reflecting contemporary evidence and expert consensus; the SIAIP promoted an updated position paper.

A multidisciplinary panel of experts reviewed the previous document, taking into account international guidelines and key publications on pediatric chronic cough, and integrated the available evidence with clinical expertise. Consensus discussions focused on red flags and specific cough pointers, the classification of cough as wet or dry, treatable traits, and the role of time-limited therapeutic trials with predefined reassessment.

The proposed algorithm prioritizes the early identification of red flags that indicate the need for targeted investigations and specialist referral. In children without warning features, cough quality guides subsequent management. Wet cough is addressed primarily through the recognition and appropriate treatment of infective causes, such as protracted bacterial bronchitis. Dry cough is evaluated sequentially for cough-predominant asthma, upper airway cough syndrome, gastroesophageal reflux-related mechanisms, and functional cough. At each step, empirical therapies are limited and require scheduled reassessment, with discontinuation if ineffective. The approach emphasizes the avoidance of prolonged empirical therapy, the rational use of antibiotics, inhaled corticosteroids, alginates, and proton pump inhibitors, and the early reconsideration of the diagnosis when the response is lacking.

This pragmatic algorithm provides a structured, clinically oriented approach to standardize the evaluation and management of chronic cough in children and adolescents. It is intended to support clinical judgment, reduce unwarranted variation in practice, minimize unnecessary investigations and treatments, and promote the timely identification of conditions requiring specialist care. Prospective validation in real-world settings is warranted to assess its impact on outcomes and healthcare utilization.