Diagnostic Utility of Specific Frailty Questionnaire: The Kihon Checklist for Hippocampal Atrophy in COPD.

Background/Objectives: COPD patients who are frail have been reported to develop brain atrophy, but no non-invasive diagnostic tool has been developed to detect this condition. Our study aimed to explore the diagnostic utility of the Kihon Checklist (KCL), a frailty questionnaire, in assessing hippocampal volume loss in patients with COPD. Methods: We recruited 40 COPD patients and 20 healthy individuals using the KCL to assess frailty across seven structural domains. Hippocampal volumes were obtained from T1-weighted MRI images, and ROC analysis was performed to detect hippocampal atrophy. Results: Our results showed that patients with COPD had significantly greater atrophic left hippocampal volumes than healthy subjects (p < 0.05). The univariate correlation coefficient between the left hippocampal volume and KCL (1-20), which pertains to instrumental and social activities of daily living, was the largest (ρ = -0.54, p < 0.0005) among the KCL subdomains. Additionally, both KCL (1-25) and KCL (1-20) demonstrated useful diagnostic potential (93% specificity and 90% sensitivity, respectively) for identifying individuals in the lowest 25% of the left hippocampal volume (AUC = 0.82). Conclusions: Our study suggests that frailty questionnaires focusing on daily vulnerability, such as the KCL, can effectively detect hippocampal atrophy in COPD patients.

Kinetics of pro- and anti-inflammatory spike-specific cellular immune responses in long-term care facility residents after COVID-19 mRNA primary and booster vaccination: a prospective longitudinal study in Japan.

BACKGROUND: The magnitude and durability of cell-mediated immunity in older and severely frail individuals following coronavirus disease 2019 (COVID-19) vaccination remain unclear. A controlled immune response could be the key to preventing severe COVID-19; however, it is uncertain whether vaccination induces an anti-inflammatory cellular immune response. To address these issues, a 48-week-long prospective longitudinal study was conducted. A total of 106 infection-naive participants (57 long-term care facility [LTCF] residents [median age; 89.0 years], 28 outpatients [median age; 72.0 years], and 21 healthcare workers [median age; 51.0 years]) provided peripheral blood mononuclear cell (PBMC) samples for the assessment of spike-specific PBMC responses before primary vaccination, 24 weeks after primary vaccination, and three months after booster vaccination. Cellular immune responses to severe acute respiratory syndrome coronavirus 2 spike protein were examined by measuring interferon (IFN)-γ, tumor necrosis factor (TNF), interleukin (IL)-2, IL-4, IL-6, and IL-10 levels secreted from the spike protein peptide-stimulated PBMCs of participants. RESULTS: LTCF residents exhibited significantly lower IFN-γ, TNF, IL-2, and IL-6 levels than healthcare workers after the primary vaccination. Booster vaccination increased IL-2 and IL-6 levels in LTCF residents comparable to those in healthcare workers, whereas IFN-γ and TNF levels in LTCF residents remained significantly lower than those in healthcare workers. IL-10 levels were not significantly different from the initial values after primary vaccination but increased significantly after booster vaccination in all subgroups. Multivariate analysis showed that age was negatively associated with IFN-γ, TNF, IL-2, and IL-6 levels but not with IL-10 levels. The levels of pro-inflammatory cytokines, including IFN-γ, TNF, IL-2, and IL-6, were positively correlated with humoral immune responses, whereas IL-10 levels were not. CONCLUSIONS: Older and severely frail individuals may exhibit diminished spike-specific PBMC responses following COVID-19 vaccination compared to the general population. A single booster vaccination may not adequately enhance cell-mediated immunity in older and severely frail individuals to a level comparable to that in the general population. Furthermore, booster vaccination may induce not only a pro-inflammatory cellular immune response but also an anti-inflammatory cellular immune response, potentially mitigating detrimental hyperinflammation.

Management Reality of Female Patients with COPD: A Multicenter Cross-Sectional CAP Study in Japan.

Background: Reports from Europe and North America suggest that female chronic obstructive pulmonary disease (COPD) patients have a higher symptom burden and mortality than male patients. However, little is known about the management reality of female patients with COPD in Japan. Patients and Methods: We compared the clinical characteristics of female COPD patients with those of male using the cohort of the COPD Assessment in Practice study, which is a cross-sectional multicenter observational study. Results: Of the 1168 patients, 133 (11.4%) were female. A history of never smoking was higher in females than males (p<0.01). Although there was no difference in age or forced expiratory volume in one second (FEV1) % predicted between the groups, modified medical research council dyspnea scale (mMRC) and number of frequent exacerbators were higher in females (mMRC≥2: p<0.01; number of exacerbations≥2: p=0.011). The mean forced vital capacity and FEV1 values in females were lower than those in males (p<0.0001 and p<0.0001, respectively). Females were more likely to use long-term oxygen therapy and inhaled corticosteroids than males (p=0.016 and p<0.01, respectively). The prevalence of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, D (ABCD GOLD 2017 classification), and E (ABE GOLD 2023 classification) was higher in females than in males. Conclusion: The disease burden of female patients with COPD is higher than that of male patients in Japan, suggesting the importance of interventions considering female-dominant features such as lower absolute FVC and FEV1, respiratory failure, and asthma-like conditions.

Gender Difference in the Relationship between Extrapulmonary Factors and Reduced Lung Function in Early Adulthood.

(1) Background: Reduced lung function in early adulthood is associated with future risks to health outcomes that have not been fully explored by gender. We investigated gender-specific relationships between lung function and extrapulmonary variables, assessing their potential as screening markers for respiratory dysfunction in young adults. (2) Methods: The participants were 151 medical students. Clinical data, handgrip strength (HS); body composition parameters such as skeletal muscle mass index (SMI), whole-body phase angle (WBPhA), and bone mineral content (BMC); and pulmonary function variables, vital capacity (VC), forced VC (FVC), and forced expiratory volume in one second (FEV1), were measured. (3) Results: FEV1 was significantly correlated with BMI, SMI, WBPhA, BMC, and both left and right HS (p < 0.0001, respectively) across all participants. According to gender, FEV1 had the strongest positive association with left HS in males (p < 0.0001) and BMC in females (p < 0.0001). The area under the curve for detecting the bottom quartile of FEV1 was 0.705 (cut-off 41.0 kg, sensitivity 91%) for left HS in males and 0.742 (cut-off 2.11 kg, sensitivity 81%) for BMC in females. (4) Conclusions: Gender-specific relationships between intrapulmonary and extrapulmonary factors such as left HS and BMC could be useful for screening suspected respiratory dysfunction in early adulthood.

Correlation between frailty and reduction in cortical thickness in patients with chronic obstructive pulmonary disease.

Physical inactivity and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) can lead to frailty and poor prognoses. However, little is known regarding the association between frailty and the human brain. We hypothesized that the brain structure could change according to frailty in patients with COPD and focused on cortical thickness. Cortical thickness measured by magnetic resonance imaging and frailty scores using the Kihon Checklist (KCL) were assessed in 40 patients with stable COPD and 20 healthy controls. Among the 34 regions assessed, multiple regions were thinner in patients with COPD than in healthy individuals (p < 0.05). We found significant negative correlations between the eight regions and the KCL scores only in patients with COPD. After adjusting for age and cognitive impairment, the association between the left and six right regions remained statistically significant. The correlation coefficient was the strongest in the bilateral superior frontal gyrus (left: ρ = - 0.5319, p = 0.0006) (right: ρ = - 0.5361, p = 0.0005). Interestingly, among the KCL scores, the daily activity domain showed the strongest correlation (sensitivity, 90%; specificity, 73%) with the bottom quartile of the reduction in the superior frontal gyrus. Frailty in patients with COPD is associated with a thickness reduction in the cortical regions, reflecting social vulnerability.

Multi-scale simulations of pulmonary airflow based on a coupled 3D-1D-0D model.

Pulmonary airflow simulation is a valuable tool for studying respiratory function and disease. However, the respiratory system is a complex multiscale system that involves various physical and biological processes across different spatial and temporal scales. In this study, we propose a 3D-1D-0D multiscale method for simulating pulmonary airflow, which integrates different levels of detail and complexity of the respiratory system. The method consists of three components: a 3D computational fluid dynamics model for the airflow in the trachea and bronchus, a 1D pipe model for the airflow in the terminal bronchioles, and a 0D biphasic mixture model for the airflow in the respiratory bronchioles and alveoli coupled with the lung deformation. The coupling between the different components is achieved by satisfying the mass and momentum conservation law and the pressure continuity condition at the interfaces. We demonstrate the validity and applicability of our method by comparing the results with data of previous models. We also investigate the reduction in inhaled air volume due to the pulmonary fibrosis using the developed multiscale model. Our method provides a comprehensive and realistic framework for simulating pulmonary airflow and can potentially facilitate the diagnosis and treatment of respiratory diseases.

Relief of Airflow Limitation and Airway Inflammation by Endoscopic Sinus Surgery in a Patient with Severe Asthma with Eosinophilic Chronic Rhinosinusitis.

Although endoscopic sinus surgery (ESS) is beneficial in improving asthma symptoms, its impact on the lung function in patients with asthma and chronic rhinosinusitis remains unclear. We herein report a case of severe asthma with eosinophilic chronic rhinosinusitis, in which ESS substantially improved airflow limitation and concomitantly reduced fractional exhaled nitric oxide and blood eosinophil counts. ESS likely relieved airflow limitation by suppressing type 2 inflammatory pathways. This case highlights ESS as a promising strategy for achieving clinical remission in patients with severe asthma and chronic rhinosinusitis.

Kinetics of COVID-19 mRNA primary and booster vaccine-associated neutralizing activity against SARS-CoV-2 variants of concern in long-term care facility residents: a prospective longitudinal study in Japan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) remains a threat to vulnerable populations such as long-term care facility (LTCF) residents, who are often older, severely frail, and have multiple comorbidities. Although associations have been investigated between COVID-19 mRNA vaccine immunogenicity, durability, and response to booster vaccination and chronological age, data on the association of clinical factors such as performance status, nutritional status, and underlying comorbidities other than chronological age are limited. Here, we evaluated the anti-spike IgG level and neutralizing activity against the wild-type virus and Delta and Omicron variants in the sera of LTCF residents, outpatients, and healthcare workers before the primary vaccination; at 8, 12, and 24 weeks after the primary vaccination; and approximately 3 months after the booster vaccination. This 48-week prospective longitudinal study was registered in the UMIN Clinical Trials Registry (Trial ID: UMIN000043558). RESULTS: Of 114 infection-naïve participants (64 LTCF residents, 29 outpatients, and 21 healthcare workers), LTCF residents had substantially lower anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant than outpatients and healthcare workers over 24 weeks after the primary vaccination. In LTCF residents, booster vaccination elicited neutralizing activity against the wild-type virus and Delta variant comparable to that in outpatients, whereas neutralizing activity against the Omicron variant was comparable to that in outpatients and healthcare workers. Multiple regression analyses showed that age was negatively correlated with anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant after the primary vaccination. However, multivariate regression analysis revealed that poor performance status and hypoalbuminemia were more strongly associated with a lower humoral immune response than age, number of comorbidities, or sex after primary vaccination. Booster vaccination counteracted the negative effects of poor performance status and hypoalbuminemia on the humoral immune response. CONCLUSIONS: LTCF residents exhibited suboptimal immune responses following primary vaccination. Although older age is significantly associated with a lower humoral immune response, poor performance status and hypoalbuminemia are more strongly associated with a lower humoral immune response after primary vaccination. Thus, booster vaccination is beneficial for older adults, especially those with a poor performance status and hypoalbuminemia.

Neural Network Approach to Investigating the Importance of Test Items for Predicting Physical Activity in Chronic Obstructive Pulmonary Disease.

Contracting COPD reduces a patient's physical activity and restricts everyday activities (physical activity disorder). However, the fundamental cause of physical activity disorder has not been found. In addition, costly and specialized equipment is required to accurately examine the disorder; hence, it is not regularly assessed in normal clinical practice. In this study, we constructed a machine learning model to predict physical activity using test items collected during the normal care of COPD patients. In detail, we first applied three types of data preprocessing methods (zero-padding, multiple imputation by chained equations (MICE), and k-nearest neighbor (kNN)) to complement missing values in the dataset. Then, we constructed several types of neural networks to predict physical activity. Finally, permutation importance was calculated to identify the importance of the test items for prediction. Multifactorial analysis using machine learning, including blood, lung function, walking, and chest imaging tests, was the unique point of this research. From the experimental results, it was found that the missing value processing using MICE contributed to the best prediction accuracy (73.00%) compared to that using zero-padding (68.44%) or kNN (71.52%), and showed better accuracy than XGBoost (66.12%) with a significant difference (p < 0.05). For patients with severe physical activity reduction (total exercise < 1.5), a high sensitivity (89.36%) was obtained. The permutation importance showed that "sex, the number of cigarettes, age, and the whole body phase angle (nutritional status)" were the most important items for this prediction. Furthermore, we found that a smaller number of test items could be used in ordinary clinical practice for the screening of physical activity disorder.

Assessing four-dimensional CT stress maps derived from patient-specific biomechanical models of the lung with pulmonary function test data in lung cancer patients.

OBJECTIVE: This study aims to retrospectively compare the stress map of the lung with pulmonary function test (PFT) results in lung cancer patients and to evaluate the potential of the stress map as an imaging biomarker for chronic obstructive pulmonary disease (COPD). METHODS: 25 lung cancer patients with pre-treatment four-dimensional CT (4DCT) and PFT data were retrospectively analysed. PFT metrics were used to diagnose obstructive lung disease. For each patient, forced expiratory volume in 1 s (FEV1 % predicted) and the ratio of FEV1 and forced vital capacity (FEV1/FVC) were recorded. 4DCT and biomechanical model-deformable image registration (BM-DIR) were used to obtain the lung stress map. The relationship between the mean of the total lung stress and PFT data was evaluated, and the COPD classification grade was also evaluated. RESULTS: The mean values of the total lung stress and FEV1 % predicted showed a significant strong correlation [R = 0.833, (p < 0.001)]. The mean values and FEV1/FVC showed a significant strong correlation [R = 0.805, (p < 0.001)]. For the total lung stress, the area under the curve and the optimal cut-off value were 0.94 and 510.8 Pa for the classification of normal or abnormal lung function, respectively. CONCLUSION: This study has demonstrated the potential of lung stress maps based on BM-DIR to accurately assess lung function by comparing them with PFT data. ADVANCES IN KNOWLEDGE: The derivation of stress map directly from 4DCT is novel method. The BM-DIR-based lung stress map can provide an accurate assessment of lung function.

Utility of the Shortness of Breath in Daily Activities Questionnaire (SOBDA-Q) to Detect Sedentary Behavior in Patients with Chronic Obstructive Pulmonary Disease (COPD).

Sedentary behavior has been shown to be an independent predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). However, physicians have difficulty ascertaining patients' activity levels because they tend to avoid shortness of breath. The reformed shortness of breath (SOB) in the daily activities questionnaire (SOBDA-Q) specifies the degree of SOB by measuring low-intensity activity behavior in everyday living. Therefore, we aimed to explore the utility of the SOBDA-Q in detecting sedentary COPD. We compared the modified Medical Research Council dyspnea scale (mMRC), COPD assessment test (CAT), and SOBDA-Q with physical activity levels (PAL) in 17 healthy patients, 32 non-sedentary COPD patients (PAL ≥ 1.5 METs·h), and 15 sedentary COPD patients (PAL < 1.5 METs·h) in this cross-sectional study. CAT and all domains of the SOBDA-Q in all patients are significantly correlated with PAL, even after adjusting for age. The dietary domain has the highest specificity, and the outdoor activity domain has the highest sensitivity for detecting sedentary COPD. Combining these domains helped determine patients with sedentary COPD (AUC = 0.829, sensitivity = 1.00, specificity = 0.55). The SOBDA-Q is associated with PAL and could be a useful tool for determining patients with sedentary COPD. Moreover, eating and outing inactivity claims reflect sedentary behavior in patients with COPD.

Prospective Real-World Analysis of Asthma Patients With Preserved and Reduced Physical Activity.

BACKGROUND: Asthma is a highly heterogeneous airway disease, and the clinical characteristics of patients with asthma with preserved and reduced physical activity are poorly understood. OBJECTIVE: We aimed to investigate the risk factors and clinical phenotypes associated with reduced physical activity in a wide range of patients with asthma. METHODS: We conducted a prospective observational study of 138 patients with asthma, including patients with asthma without chronic obstructive pulmonary disease (COPD) (n = 104) and asthma-COPD overlap (n = 34), and 42 healthy controls. Physical activity levels were measured for 2 weeks using a triaxial accelerometer at baseline and 1 year later. RESULTS: Higher eosinophils and body mass index (BMI) were associated with reduced physical activity in patients with asthma without COPD. Cluster analysis of asthma without COPD revealed 4 asthma phenotypes. We identified a cluster with preserved physical activity (n = 43) that was characterized by good symptom control and lung function and included a high proportion of biologics users (34.9%). Multivariate regression analysis revealed that patients with late-onset eosinophilic (n = 21), high-BMI noneosinophilic (n = 14), and symptom-predominant asthma phenotypes (n = 26) had lower levels of physical activity than controls. Patients with asthma-COPD overlap also had significantly lower physical activity levels than controls. Similar trends in physical activity levels were observed in each asthma group at 1-year follow-up. CONCLUSION: This study showed the clinical features of patients with asthma with preserved and reduced physical activity. Reduced physical activity was observed in various asthma phenotypes and in asthma-COPD overlap.

A case of development of autoimmune pulmonary alveolar proteinosis during the treatment of hypersensitivity pneumonitis.

Herein, we report the case of a 73-year-old woman with an occupational history of plaster grinding who developed autoimmune pulmonary alveolar proteinosis (PAP) during the treatment of fibrotic hypersensitivity pneumonitis with steroids and immunosuppressive drugs. Based on the changes in computed tomography imaging findings, poor response to steroid therapy, and markedly elevated KL-6 levels, PAP was suspected and diagnosed by bronchoscopy. Repeated segmental bronchoalveolar lavage under high-flow nasal cannula oxygen therapy resulted in slight improvement. Steroids and immunosuppressive treatments for other interstitial lung diseases may cause PAP or exacerbate latent PAP.

A Real-World Study of Achievement Rate and Predictive Factors of Clinical and Deep Remission to Biologics in Patients with Severe Asthma.

BACKGROUND: Recent advances in biologics have provided new insights into the clinical course of asthma, including disease modification, clinical remission (CR), and deep remission (DR). However, the extent to which biologics achieve CR and DR in severe asthma patients is poorly understood. METHODS: To assess the achievement rate and predictors of CR and DR using long-term biologics, we retrospectively evaluated 54 severe asthma patients recently started on biologics. "CR" denotes the achievement of all three criteria: (1) absence of asthma symptoms, (2) no asthma exacerbations, and (3) no use of oral corticosteroids. DR denoted CR plus (4) normalized pulmonary function and (5) suppressed type 2 inflammation. RESULTS: CR and DR achievement rates were 68.5% and 31.5%, respectively. Compared with the non-deep remission group, the DR group had higher adult-onset asthma rates (94.1% vs. 70.3%, p = 0.078), shorter asthma duration (5 vs. 19 years, p = 0.006), and higher FEV1 (91.5% vs. 71.5%, p < 0.001). There were no significant differences in the Asthma Control Questionnaire scores, exacerbation frequency, or type 2 inflammation at baseline between groups. Asthma duration combined with FEV1 can stratify the achievement rates of CR and DR. CONCLUSIONS: the early introduction of biologics in severe asthma patients may help achieve CR and DR.

Computed Tomography Lung Density Analysis: An Imaging Biomarker Predicting Physical Inactivity in Chronic Obstructive Pulmonary Disease: A Pilot Study.

Physical inactivity correlates with poor prognosis in chronic obstructive pulmonary disease (COPD) and is suggested to be related to lung hyperinflation. We examined the association between physical activity and the expiratory to inspiratory (E/I) ratio of mean lung density (MLD), the imaging biomarker of resting lung hyperinflation. COPD patients (n = 41) and healthy controls (n = 12) underwent assessment of pulmonary function and physical activity with an accelerometer, as well as computed tomography at full inspiration and expiration. E/IMLD was calculated by measuring inspiratory and expiratory MLD. Exercise (EX) was defined as metabolic equivalents × duration (hours). COPD patients had higher E/IMLD (0.975 vs. 0.964) than healthy subjects. When dividing COPD patients into sedentary (EX < 1.5) and non-sedentary (EX ≥ 1.5) groups, E/IMLD in the sedentary group was statistically higher than that in the non-sedentary group (0.983 vs. 0.972). E/IMLD > 0.980 was a good predictor of sedentary behavior in COPD (sensitivity, 0.815; specificity, 0.714). Multivariate analysis showed that E/IMLD was associated with sedentary behavior (odds ratio, 0.39; p = 0.04), independent of age, symptomology, airflow obstruction, and pulmonary diffusion. In conclusion, higher E/IMLD scores are associated with sedentary behavior and can be a useful imaging biomarker for the early detection of physical inactivity in COPD.

Investigation of the combination of intratumoral and peritumoral radiomic signatures for predicting epidermal growth factor receptor mutation in lung adenocarcinoma.

PURPOSE: We investigated optimal peritumoral size and constructed predictive models for epidermal growth factor receptor (EGFR) mutation. METHODS: A total of 164 patients with lung adenocarcinoma were retrospectively analyzed. Radiomic signatures for the intratumoral region and combinations of intratumoral and peritumoral regions (3, 5, and 7 mm) from computed tomography images were extracted using analysis of variance and least absolute shrinkage. The optimal peritumoral region was determined by radiomics score (rad-score). Intratumoral radiomic signatures with clinical features (IRS) were used to construct predictive models for EGFR mutation. Combinations of intratumoral and 3, 5, or 7 mm-peritumoral signatures with clinical features (IPRS3, IPRS5, and IPRS7, respectively) were also used to construct predictive models. Support vector machine (SVM), logistic regression (LR), and LightGBM models with five-fold cross-validation were constructed, and the receiver operating characteristics were evaluated. Area under the curve (AUC) of the training and test cohorts values were calculated. Brier scores (BS) and decision curve analysis (DCA) were used to evaluate the predictive models. RESULTS: The AUC values of the SVM, LR, and LightGBM models derived from IRS were 0.783 (95% confidence interval: 0.602-0.956), 0.789 (0.654-0.927), and 0.735 (0.613-0.958) for training, and 0.791 (0.641-0.920), 0.781 (0.538-0.930), and 0.734 (0.538-0.930) for test cohort, respectively. Rad-score confirmed that the 3 mm-peritumoral size was optimal (IPRS3), and AUCs values of SVM, LR, and lightGBM models derived from IPRS3 were 0.831 (0.666-0.984), 0.804 (0.622-0.908), and 0.769 (0.628-0.921) for training and 0.765 (0.644-0.921), 0.783 (0.583-0.921), and 0.796 (0.583-0.949) for test cohort, respectively. The BS and DCA of the LR and LightGBM models derived from IPRS3 were better than those from IRS. CONCLUSION: Accordingly, the combination of intratumoral and 3 mm-peritumoral radiomic signatures may be helpful for predicting EGFR mutations.

Detection of impaired gas exchange using the 1-minute sit-to-stand test in patients with interstitial lung disease.

BACKGROUND: Although pulmonary function tests (PFTs) are important in patients with interstitial lung disease (ILD), they cannot be easily performed in a primary healthcare setting. This study aimed to examine the usefulness of the difference between pulse oxygen saturation (SpO2) at rest and the lowest SpO2 during the 1-min sit-to-stand test (delta SpO2-1STST) for predicting pulmonary function impairment. METHODS: We retrospectively reviewed 116 patients with ILD who underwent 1STST and PFTs. RESULTS: The delta SpO2-1STST and diffusing capacity for carbon monoxide (DLco) strongly correlated (ρ = 0.70). The delta SpO2-1STST was effective in predicting impaired gas exchange (cut-off value, -4%; AUC, 0.86; sensitivity, 74%; specificity, 87%). CONCLUSIONS: The Delta SpO2-1STST may be a reasonable tool for predicting abnormalities in PFTs.

Practical Recommendations for a Selection of Inhaled Corticosteroids in COPD: A Composite ICO Chart.

The use of inhaled corticosteroids (ICS) for the maintenance of bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD) is controversial. While some patients achieve clinical benefits, such as fewer exacerbations and improved symptoms, others do not, and some experience undesired side effects, such as pneumonia. Thus, we reviewed the evidence related to predictors of ICS therapy treatment response in patients with COPD. The first priority clinical markers when considering the efficacy of ICS are type 2 inflammatory biomarkers, followed by a history of suspected asthma and recurrent exacerbations. It is also necessary to consider any potential infection risk associated with ICS, and several risk factors for pneumonia when using ICS have been clarified in recent years. In this article, based on the evidence supporting the selection of ICS for COPD, we propose an ICS composite that can be added to the COPD (ICO) chart for use in clinical practice. The chart divided the type 2 biomarkers into three ranges and provided recommendations (recommend, consider, and against) by combining the history of suspected asthma, history of exacerbations, and risk of infection.

Comparison of the radiomics-based predictive models using machine learning and nomogram for epidermal growth factor receptor mutation status and subtypes in lung adenocarcinoma.

The purpose of this study is to develop the predictive models for epidermal growth factor receptor (EGFR) mutation status and subtypes [exon 21-point mutation (L858R) and exon 19 deletion mutation (19Del)] and evaluate their clinical usefulness. Total 172 patients with lung adenocarcinoma were retrospectively analyzed. The analysis of variance and the least absolute shrinkage were used for feature selection from plain computed tomography images. Then, radiomic score (rad-score) was calculated for the training and test cohorts. Two machine learning (ML) models with 5-fold were applied to construct the predictive models with rad-score, clinical features, and the combination of rad-score and clinical features. The nomogram was developed using rad-score and clinical features. The prediction performance was evaluated by the area under the receiver operating characteristic curve (AUC). Finally, decision curve analysis (DCA) was performed using the best ML and nomogram models. In the test cohorts, the AUC of the best ML and the nomogram model were 0.73 (95% confidence interval, 0.59-0.87) and 0.79 (0.65-0.92) in the EGFR mutation groups, 0.83 (0.67-0.99) and 0.85 (0.72-0.97) in the L858R mutation groups, as well as 0.77 (0.58-0.97) and 0.77 (0.60-0.95) in the 19Del groups. The DCA showed that the nomogram models have comparable results with ML models. We constructed two predictive models for EGFR mutation status and subtypes. The nomogram models had comparable results to the ML models. Because the superiority of the performance of ML and nomogram models varied depending on the prediction groups, appropriate model selection is necessary.

Measurement of Blood Eosinophils in Asthma and Chronic Obstructive Pulmonary Disease.

Eosinophils are important effector cells in airway inflammation, as pleiotropy and heterogeneity can be linked to various pathophysiologies in asthma and chronic obstructive pulmonary disease (COPD). Sputum eosinophils can reflect the heterogeneity of airway inflammation, and owing to their traits, blood eosinophils can be a surrogate and potential biomarker for managing both conditions. Blood eosinophils are activated via the stimulation of type 2 cytokines, such as interleukin (IL)-5, IL-4/13, granulocyte-macrophage colony-stimulating factor, IL-33, and thymic stromal lymphopoietin. There is sufficient evidence to support the relationship between the blood eosinophil count and clinical outcomes, including pulmonary function decline, exacerbations, all-cause mortality, and treatment response to inhaled corticosteroids and biologics. Thus, there is growing interest in the use of blood eosinophils for the management of these diseases. Compiling recent evidence, we herein review the significance of measuring blood eosinophils in asthma and COPD.