BMC Pulmonary Medicine

Our medical research library holds 28 studies published in BMC Pulmonary Medicine (2013–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 28 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: BioMed Central
• Published: 2001 to the present, England
• Language: English
• ISSN: 1471-2466 (electronic)
• Its record in the NLM Catalog

2020s

• Bronchoalveolar lavage cell differential count is associated with survival and radiological UIP pattern in familial pulmonary fibrosis. H. Jaula, J. Leppänen, L. Mattila, et al. 2026;26(1):84. PubMed · Publisher · Free full text

  Abstract

  BACKGROUND: Bronchoalveolar lavage fluid (BAL) cell differential count analysis is a common diagnostic tool in interstitial lung diseases (ILD), but studies of the BAL cell profile in familial pulmonary fibrosis (FPF) are sparse. In this retrospective cohort study, we aimed to determine BAL cell profile in patients with FPF and to compare findings to those with idiopathic pulmonary fibrosis (IPF) or asbestosis. We also investigated BAL cell profile according to clinical features, radiological usual interstitial pneumonia (UIP) patterns, survival and additionally in the subgroups of the patients with pathogenic gene variants and histological investigations. METHODS: Data were collected from medical records between 1 January 2000 and 30 September 2024. The inclusion criterion was pulmonary fibrosis (PF) (ICD 10-code J84.X), with at least one self-reported relative with PF and BAL data available. High-resolution computer tomography (HRCT) scans and histology were re-evaluated. RESULTS: The BAL results of 49 FPF patients were compared with 72 IPF and 90 asbestosis cases. Differences in BAL cell profile were revealed between groups of FPF, IPF, and asbestosis. Furthermore, we found differences in BAL cell profile between smoking habits and radiological UIP patterns. The BAL results of the patients with pathogenic gene variants were variable. Moreover, BAL eosinophils associated with survival in FPF and familial IPF. CONCLUSIONS: As a novel finding, a high proportion of BAL eosinophils is associated with shortened survival of patients with FPF, thus emphasising the need to further investigate the role of eosinophils in the pathogenesis of FPF.

• Diagnosis and management of pleural mesothelioma: three unique cases and review of the literature. Z. Al Achkar, D. Gaspard, M. Iskandar. 2026;26(1). Case report · Review PubMed · Publisher · Free full text

  Abstract

  BACKGROUND: Mesothelioma is a rare pleural tumor. Compared to diffuse pleural mesothelioma, localized pleural mesothelioma carries a better prognosis and may be managed with surgical resection. Among histologic subtypes, the sarcomatoid variant is the least common but is associated with the poorest outcome. Diagnosis remains challenging, with immunohistochemistry playing a central role in confirming the disease. While surgical resection is the cornerstone of management, chemotherapy, immunotherapy and radiotherapy are considered in unresectable cases. Overall, mesothelioma continues to carry a poor prognosis. CASE PRESENTATION: We describe three cases of pleural mesothelioma that posed diagnostic and therapeutic challenges. The first case involved a rapidly progressive sarcomatoid mesothelioma, initially raising concern for Ewing’s sarcoma, which was excluded based on negative immunohistochemical markers. The second case was an epithelioid mesothelioma successfully treated with extrapleural pneumonectomy followed by adjuvant chemotherapy and immunotherapy, resulting in prolonged survival. The third case, the only one with documented asbestos exposure, represents the first reported instance of synchronous epithelioid mesothelioma and invasive ductal carcinoma of the breast. CONCLUSION: Mesothelioma is a rare and complex pleural malignancy that may present in atypical ways, complicating both diagnosis and management. These cases underscore the importance of immunohistochemical profiling, highlight the value of multidisciplinary diagnostic approaches, and reaffirm the pivotal role of surgery within the therapeutic algorithm.

• Diagnostic value of biochemical ratios in the differential diagnosis of tuberculous and malignant pleural effusions. U. İlhan, Z. Güney, A. Özçelik, et al. 2026;26(1). PubMed · Publisher · Free full text

  Abstract

  Background And Objective: The differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) in patients with pleural effusion (PE) continues to pose significant clinical challenges. While conventional pleural fluid cytology has limited sensitivity, invasive diagnostic procedures are often costly or inaccessible, particularly in resource-limited settings. In this study, we investigated the diagnostic contribution of ratios derived from pleural fluid adenosine deaminase (ADA), total protein, serum lactate dehydrogenase (S-LDH), and pleural effusion lactate dehydrogenase (PE-LDH) levels in patients with histopathological confirmed pleural effusion etiology. Specifically, the diagnostic performance of biochemical and hematological parameters, particularly the ADA/serum protein, S-LDH/ADA and PE-LDH/ADA ratios were evaluated for their ability to discriminate between TPE and MPE.

  Methods: This retrospective cross-sectional study was conducted among patients who underwent diagnostic evaluation and treatment for pleural effusion at a tertiary referral hospital between 1 November 2014 and 1 November 2024. A total of 1,003 patients with pleural effusion (397 TPE and 606 MPE: 409 primary, 133 metastatic, and 64 mesothelioma) were included, whose etiologies were determined using a composite reference standard based on clinical, radiological, microbiological, and histopathological findings, with multidisciplinary team (MDT) evaluation applied in selected cases where appropriate. Receiver operating characteristic (ROC) curve analyses were performed to determine diagnostic accuracy, sensitivity, specificity, and optimal cut-off values.

  Results: Patients with TPE were significantly younger than those with MPE (median age: 32 vs. 65 years, p < .001). Overall, 62.9% of the study population were male. ADA levels were significantly higher in the TPE group, whereas S-LDH levels were higher in the malignant effusion group. When ratio-based parameters were evaluated, the S-LDH/ADA ratio was markedly higher in patients with malignant pleural effusion and emerged as the most powerful discriminatory marker, with an area under the curve (AUC) of 0.938, sensitivity of 89.5%, and specificity of 91.3%. The ADA/serum protein ratio also demonstrated high diagnostic accuracy for differentiating TPE, with an AUC of 0.929, sensitivity of 89.9%, and specificity of 93.3%. In multivariate analysis, the S-LDH/ADA ratio, ADA/serum protein ratio, and PE-LDH/ADA ratio remained independently associated with diagnostic discrimination between TPE and MPE.

  Conclusions: Biochemical ratios particularly the S-LDH/ADA and PE-ADA/serum protein ratios are reliable, minimally invasive diagnostic tools for distinguishing TPE from MPE. These ratios are especially useful in guiding clinical decision-making in settings where access to invasive diagnostic procedures is limited.

  © 2026. The Author(s).

• Distinct comorbidity profiles and outcomes in asbestosis versus idiopathic pulmonary fibrosis: a 6-year prospective cohort study. Y. Song, Y. Wang, N. Dilixiati, et al. 2026;26(1). PubMed · Publisher · Free full text

  Abstract

  Background: Asbestosis and idiopathic pulmonary fibrosis (IPF) share overlapping clinical and pathological features; however, differences in comorbidities and prognostic patterns between the two diseases remain poorly defined. This study aimed to compare comorbidities and prognostic factors associated with pulmonary fibrosis progression and mortality in asbestosis and IPF.

  Methods: This prospective cohort study included 254 patients with asbestosis and 548 patients with IPF enrolled between 2016 and 2020, with follow-up through 2022. Outcomes included progressive pulmonary fibrosis (PPF) and all-cause mortality. Multivariable Cox models were applied to identify independent risk factors associated with these outcomes.

  Results: Patients with asbestosis exhibited a higher comorbidity burden. Specifically, they more frequently had asthma, lung cancer, pleural disease, cardiovascular/cerebrovascular disease, and connective tissue disease, whereas emphysema was more common in IPF (all P < 0.05). Over a median follow-up of 44 months (IQR 24-61), IPF patients had a higher cumulative incidence of endpoint events than those with asbestosis. In asbestosis, a usual interstitial pneumonia (UIP) pattern on HRCT predicted disease progression. In IPF, risk factors for progression included hypoxemia, forced vital capacity (FVC) < 80%, and UIP compared with probable UIP. Interestingly, combined emphysema was protective against IPF progression. Mortality in asbestosis was associated with lung cancer, pulmonary hypertension (PH), and atrial fibrillation, whereas in IPF, it was linked to FVC < 80% and PH.

  Conclusions: Asbestosis and IPF show distinct comorbidity patterns and prognostic drivers. IPF prognosis is mainly determined by fibrosis severity, while asbestosis mortality is driven largely by asbestos-related complications.

  © 2026. The Author(s).

• Recovery from fulminant immune-related myocarditis induced by ipilimumab plus nivolumab in malignant pleural mesothelioma: a case report. Y. Konya, J. Tanizaki, K. Onishi, et al. 2026;26(1). Case report PubMed · Publisher · Free full text

  Abstract

  BACKGROUND: Immune checkpoint inhibitors (ICIs) have become standard therapies for various cancers; however, their use can lead to diverse immune-related adverse events (irAEs). While most irAEs are mild, some, such as myocarditis, although rare, have a high mortality rate. This report highlights a case in which aggressive and invasive therapeutic interventions led to successful patient survival after fulminant ICI-induced myocarditis. CASE PRESENTATION: A 64-year-old male with a malignant pleural mesothelioma was admitted to the hospital with dyspnea on day 22 after the first cycle of ipilimumab plus nivolumab. Upon admission, he presented with cardiogenic shock and pulseless ventricular tachycardia, accompanied by elevated cardiac biomarkers. Owing to a history of ICI treatment, immune-related myocarditis was suspected, and high-dose methylprednisolone was immediately initiated. As his hemodynamic status rapidly deteriorated, extracorporeal membrane oxygenation (VA-ECMO), percutaneous left ventricular assist device (pLVAD), and temporary transvenous cardiac pacing were promptly initiated to stabilize the circulation. A myocardial biopsy confirmed lymphocytic myocarditis. The patient gradually stabilized and was successfully weaned off aggressive circulatory support, leading to patient’s discharge on day 69. CONCLUSIONS: Early methylprednisolone pulse therapy is crucial in treating immune-related myocarditis. To bridge the time until the steroids become fully effective, aggressive interventions such as VA-ECMO, pLVAD, and external pacing can play a life-saving supportive role. This underscores the importance of close collaboration with cardiologists to promptly implement these bridging therapies, which are vital for patient survival.

• Who participates in LDCT screening for the early detection of lung cancer after long-term occupational exposure to asbestos dust? Results of the analysis of administrative and medical routine data from the German Social Accident Insurance. N. Oubaid, F. Greiner, H. Keller, et al. 2026;26(1). PubMed · Publisher · Free full text

  Abstract

  Background: Lung cancer is one of the most common cancers in Germany and is predominantly detected at an advanced stage. To ensure early detection, the German Social Accident Insurance (DGUV) offers lung cancer screening including a low-dose computed tomography (LDCT) for individuals with long-term occupational exposure to asbestos dust and a smoking history of at least 30 pack years. However, evidence remains scarce about what encourages this group of people to participate in LDCT screening after medical consultation.

  Methods: A secondary data analysis using routinely collected medical and administrative data between 2014 and 2024 was conducted in a cross-sectional design. This study aimed to investigate factors that could be used to predict the uptake of LDCT screening following a medical consultation. Exploratory logistic regression analysis was used to identify and assess possible predictors.

  Results: The sample included n = 14,491 individuals (97% male; average age 67 years; average asbestos dust exposure 21 years; average cigarette consumption 43 pack years). 74% of individuals underwent LDCT screening after medical consultation. 13 predictors were included in the regression model. The model demonstrated a low level of variance explanation (Nagelkerkes R2 = 0.026). Younger individuals (OR: 0.96, p < 0.001), individuals with prolonged exposure to asbestos dust (OR: 1.01, p = 0.011) and with a history of pneumonia (OR: 1.16, p = 0.011) were more likely to undergo LDCT screening.

  Conclusion: The predictors showed only a low explanatory power. Further research should include non-participants and expand the exploratory model to include theoretically grounded predictors.

  © 2026. The Author(s).

• The usefulness of full-thickness biopsy during semi-rigid pleuroscopy for differentiating between malignant pleural mesothelioma and non-specific pleurisy. T. Ueda, T. Nakai, S. Tanaka, et al. 2025;25(1):553. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant pleural mesothelioma is a rare disease with a poor prognosis; distinguishing it from non-specific pleurisy is essential for determining an appropriate treatment strategy. We aimed to evaluate the diagnostic utility and safety of full-thickness biopsy performed during semi-rigid pleuroscopy under local anaesthesia to differentiate between malignant pleural mesothelioma and non-specific pleurisy.

  Methods: Consecutive patients who attempted full-thickness biopsy using a cryoprobe or an insulated-tip diathermic knife during semi-rigid pleuroscopy between April 2019 and October 2023 were retrospectively enrolled. The diagnostic utility of full-thickness biopsy for distinguishing malignant pleural mesothelioma from non-specific pleurisy was assessed based on diagnostic accuracy, specimen quality, and procedural safety.

  Results: Among the 64 patients who underwent full-thickness biopsy, 28 diagnosed with malignant pleural mesothelioma or non-specific pleurisy were included in this study. With the exception of one malignant pleural mesothelioma case diagnosed by surgical biopsy, 13 malignant pleural mesothelioma and 14 non-specific pleurisy cases were histologically diagnosed through full-thickness biopsy, with clinical courses supporting these diagnoses. The median full-thickness biopsy specimen size was 18.8 mm² (range: 0.6-364.2 mm2), and in 25 cases (89.3%), full-thickness pleura was pathologically confirmed. Full-thickness biopsy demonstrated a sensitivity of 92.9%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an overall diagnostic accuracy of 96.4%. No severe complications were reported with the procedures.

  Conclusion: Full-thickness biopsy during semi-rigid pleuroscopy provides high diagnostic accuracy and safety for differentiating malignant pleural mesothelioma from non-specific pleurisy, while yielding high-quality pleural tissue specimens.

  © 2025. The Author(s).

• Constrictive pericarditis in a patient with fiberglass lung disease: a case report. C.Y. Hsu, H.Y. Chen, M.S. Hsieh, et al. 2024;24(1):382. Case report PubMed · Publisher · Free full text

  Abstract

  Background: Fiberglass has a larger aerodynamic diameter and is less likely to be inhaled into the lungs. Further, it will be cleared even if it is mechanically broken into smaller pieces and inhaled into the lungs. Fiberglass lung disease has been well documented if long term exposure but was thought reversible and would not cause severe diseases. The diagnosis of fiberglass lung disease depends on exposure history and histopathological findings. However, the exact occupational exposure history is often difficult to identify because mixed substance exposure often occurs and fiberglass disease is not as well-known as asbestosis.

  Case Presentation: A 66-year-old man had unexplained transudative pericardial effusion requiring pleural pericardial window operation twice at another medical center where asbestosis was told because of his self-reported long-term asbestosis exposure and the histopathological finding of a ferruginous body in his lung. Constrictive pericarditis developed two years later and resulted in congestive heart failure. Radical pericardiectomy combined with lung biopsy was performed following chest computed tomography imaging and the transudative nature of pericardial effusion not compatible with asbestosis. However, the histopathologic findings of his lung and pericardium at our hospital only showed chronic fibrosis without any asbestosis body. The patient's lung was found to be extremely fragile during a lung biopsy; histopathologic specimens were reviewed, and various fragments of fiberglass were found in the lung and pericardium. The patient's occupational exposure was carefully reevaluated, and he restated that he was only exposed to asbestosis for 1-2 years but was heavily exposed to fiberglass for more than 40 years. This misleading exposure history was mainly because he was only familiar with the dangers of asbestos. Since most fiberglass lung diseases are reversible and the symptoms of heart failure resolve soon after surgery, only observation was needed. Ten months after radical pericardiectomy, his symptoms, pleural effusion, and impaired pulmonary function eventually resolved.

  Conclusion: Fiberglass could cause inflammation of the pericardium, resulting in pericardial effusion and constrictive pericarditis, which could be severe and require radical pericardiectomy. Exact exposure history and histopathological examinations are the key to diagnosis.

  © 2024. The Author(s).

• Ectopic pleural thymoma with T-cell lymphocytosis and bone metastasis: a case report. J. Li, L. Liu, J. Li, et al. 2024;24(1):280. Case report PubMed · Publisher · Free full text

  Abstract

  Background: The diagnostic complexities that arise in radiographic distinction between ectopic pleural thymoma and other thoracic neoplasms are substantial, with instances of co-occurring T-cell lymphocytosis and osseous metastasis being exceedingly rare.

  Case Presentation: A 51-year-old woman was admitted to our hospital with dyspnea and chest pain. Upon imaging examination, she was found to have diffuse and nodular pleural thickening on the left side, collapse of the left lung and a compression in the second thoracic vertebrae. All lesions showed significant 18F-FDG uptake on 18F-FDG PET/CT examination. Furthermore, she exhibited T-cell lymphocytosis in her peripheral blood, lymph nodes, and bone marrow. After ruling out malignant pleural mesothelioma (MPM), lung cancer with pleural metastasis, and T-cell lymphoma, the definitive diagnosis asserted was ectopic pleural thymoma with T-cell lymphocytosis and bone metastasis.

  Conclusion: Physicians need to expand their knowledge of the imaging features of ectopic pleural thymoma. Cases with T-cell lymphocytosis may exhibit increased aggressiveness and prone to bone metastasis.

  © 2024. The Author(s).

• Does previous asbestos exposure increase the risk of a post coronary artery bypass graft (CABG) pleural effusion - a routine data study?. H. Welch, J. Harris, M. Pufulete, et al. 2023;23(1):307. PubMed · Publisher · Free full text

  Abstract

  Background: Development of pleural effusion (PE) following CABG is common. Post-CABG PE are divided into early- (within 30 days of surgery) and delayed-onset (30 days-1 year) which are likely due to distinct pathological processes. Some experts suggest asbestos exposure may confer an independent risk for late-onset post-CABG PE, however no large studies have explored this potential association.

  Research Question: To explore possible association between asbestos exposure and post-CABG PE using routine data.

  Methods: All patients who underwent CABG 01/04/2013-31/03/2018 were identified from the Hospital Episode Statistics (HES) Database. This England-wide population was evaluated for evidence of asbestos exposure, pleural plaques or asbestosis and a diagnosis of PE or PE-related procedure from 30 days to 1 year post-CABG. Patients with evidence of PE three months prior to CABG were excluded, as were patients with a new mesothelioma diagnosis.

  Results: 68,150 patients were identified, of whom 1,003 (1%) were asbestos exposed and 2,377 (3%) developed late-onset PE. After adjusting for demographic data, Index of Multiple Deprivation and Charlson Co-morbidity Index, asbestos exposed patients had increased odds of PE diagnosis or related procedure such as thoracentesis or drainage (OR 1.35, 95% CI 1.03-1.76, p = 0.04). In those with evidence of PE requiring procedure alone, the adjusted OR was 1.66 (95% CI 1.14-2.40, p = 0.01). Additional subgroup analysis of the 518 patients coded for pleural plaques and asbestosis alone revealed an adjusted OR of post-CABG PE requiring a procedure of 2.16 (95% CI 1.38-3.37, p = 0.002).

  Interpretation: This large-scale study demonstrates prior asbestos exposure is associated with modestly increased risk of post-CABG PE development. The risk association appears higher in patients with assigned clinical codes indicative of radiological evidence of asbestos exposure (pleural plaques or asbestosis). This association may fit with a possible inflammatory co-pathogenesis, with asbestos exposure 'priming' the pleura resulting in greater propensity for PE evolution following the physiological insult of CABG surgery. Further work, including prospective studies and clinicopathological correlation are suggested to explore this further.

  © 2023. BioMed Central Ltd., part of Springer Nature.

• High-resolution computed tomography features of asbestosis versus fibrotic hypersensitivity pneumonitis: an observational study. R. Ma, S. Li, Y. Wang, et al. 2022;22(1):207. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestosis and fibrotic hypersensitivity pneumonitis (FHP) share the pathogenetic mechanisms induced bronchiolocentric fibrotic process secondary to inhalation exposure. Under the occupational and environmental mixed exposures, asbestosis and FHP are needed to make the differential diagnoses on high-resolution computed tomography (HRCT), especially in the countries still using asbestos. The study aimed to analyze the HRCT features of asbestosis versus FHP.

  Methods: The patients with asbestosis or with HP were sequentially recruited in this comparative study at Beijing Chaoyang Hospital between January 2006 and December 2016. Patients' clinical data were obtained from a predesigned charts. The international classification of HRCT for occupational and environmental respiratory diseases was used to categorize chest imaging findings in patients. The calculation of test statistics was used to compare the imaging features of asbestosis and FHP.

  Results: 341 patients with asbestosis and 158 patients with HP were sequentially recruited, among which 204 patients with asbestosis and 74 patients with FHP were eligible for data analysis. Patients with asbestosis were older and had a longer latent period until disease manifestation than those with FHP. Asbestosis was characterized by irregular and/or linear opacities, with lower lung preponderance, accompanied by ground-glass opacities and mosaic attenuation. Notably, 98.5% of patients with asbestosis showed benign pleural abnormalities, and 39.7% of these patients had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. Abnormalities of the mediastinal and diaphragmatic pleura were observed only in cases of asbestosis, and this finding showed high specificity for the diagnosis for asbestosis compared with that for FHP. Subpleural dots or diaphragmatic pleural abnormalities showed moderate sensitivity and high specificity for diagnosis of asbestosis compared with that for FHP. Interobserver reliability was good for evaluation of imaging findings including honeycombing, pleural calcification, lymphadenectasis, and lymph node calcification.

  Conclusions: HRCT-based imaging findings can distinguish between asbestosis and FHP to a certain extent, particularly with regard to subpleural dots and diaphragmatic pleural abnormalities that characterize the former.

  © 2022. The Author(s).

• Lymphocyte predominance in blood, pleural fluid, and tumour stroma; a prognostic marker in pleural mesothelioma. D. De Fonseka, D.T. Arnold, A.J. Morley, et al. 2022;22(1):173. PubMed · Publisher · Free full text

  Abstract

  Background: As promising novel treatments develop for malignant pleural mesothelioma (MPM), early prognostication has become increasingly important. Circulating and local inflammatory cells are known to play a significant role in other tumour types. We assessed the proportion of lymphocyte populations within blood, pleural fluid and tumour stroma to prognosticate patients with MPM at diagnosis.

  Methods: Consecutive patients diagnosed with biopsy-proven MPM were prospectively recruited to an observational cohort study and followed up for a minimum of 7.5 years. Blood and pleural fluid results at presentation were extracted from the medical records. Biopsy specimens were independently reviewed by 2 pathologists who scored the degree of lymphocytic and neutrophilic infiltration.

  Results: Baseline results were available for 184 patients. The predominant pleural fluid cell type was calculable for 84 patients and 118 patients had biopsy specimens available for review. A low blood neutrophil/lymphocyte ratio (NLR < 4) inferred a better prognosis with a median survival of 420 days versus 301 days (p < 0.01). Survival was better for patients with a lymphocyte-predominant pleural effusion (430 vs 306 days, p < 0.01). Lymphocyte infiltration of tumour stroma was also associated with improved survival (n = 92, survival 430 days) compared with neutrophilic or acellular samples (n = 26, survival 342 days p < 0.01). In multivariable modelling lymphocyte predominance in blood, pleural fluid and tumour stroma were all associated with a better prognosis.

  Conclusions: Lymphocyte predominance within tumour stroma, pleural fluid or blood infers a better prognosis in patients with MPM.

  © 2022. The Author(s).

• Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters. L. Ströker, K. Peldschus, R. Herold, et al. 2022;22(1):236. PubMed · Publisher · Free full text

  Abstract

  Background: Even almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes.

  Methods: Data from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen's κ, and accuracy.

  Results: Vital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = - 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = - 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = - 0.283, - 0.274, resp.; both P < 0.05).

  Discussion: The importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.

  © 2022. The Author(s).

• Correlation between immune-related adverse events and therapeutic effects of nivolumab in patients with malignant pleural mesothelioma. H. Yoneda, H. Nokihara, A. Mitsuhashi, et al. 2021;21(1):373. PubMed · Publisher · Free full text

  Abstract

  Background: Nivolumab is used for the treatment of malignant pleural mesothelioma (MPM). However, immune-related adverse events (irAEs) occur in patients treated with nivolumab. Several studies have reported the correlation between irAEs and therapeutic effects of immune checkpoint inhibitor, but none have reported the correlation in MPM. Here we report a retrospective study which shows the correlation between irAEs and therapeutic effects of nivolumab in patients with MPM.

  Methods: This study included patients treated with nivolumab at Tokushima University Hospital from February 2009 to September 2021. We retrospectively reviewed the medical records to evaluate the several clinical factors, such as the presence or absence of irAEs, their severities, progression-free survival (PFS), overall survival (OS) or objective response to the treatment.

  Results: Eleven patients received treatment with nivolumab. Objective response rate was 18.2% and the disease control rate was 90.9%. Median PFS was 6.8 months (95% confidence interval, 1.3 to 11.9 months) and median OS was 15.2 months (95% confidence interval, 8.9 to 21.5 months). IrAEs occurred in eight patients (72.7%), and grade ≥ 2 irAEs occurred in six patients (54.5%). PFS and OS were significantly longer in the grade ≥ 2 irAEs group than in grade < 2 irAEs group (median PFS 13.6 vs. 3.8 months, p = 0.0093; median OS not reached vs. 8.6 months, p = 0.0108).

  Conclusions: This is the first study to report the correlation between irAEs and therapeutic effects in patients with MPM. Because the presence of irAEs may be associated with a favorable clinical outcome, early detection and appropriate management of irAEs will increase the therapeutic benefits to patients.

  © 2021. The Author(s).

• Downregulation of the PD-1/PD-Ls pathway in peripheral cells correlates with asbestosis severity. M. Qiu, Y. Chen, Q. Ye. 2021;21(1):175. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestosis and silicosis are characterized by diffuse or nodular interstitial lung fibrosis resulting from exposure to asbestos or silica dust, respectively. This study was designed to detect programmed cell death protein (PD-1)/programmed death ligands (PD-Ls) expression in patients with asbestosis and silicosis and to explore the possible clinical significance of PD-1/PD-Ls expression in patients with the two diseases.

  Methods: Thirty patients with asbestosis, 23 patients with silicosis and 25 healthy controls were consecutively recruited and provided informed consent to participate in the study. Clinical data were collected from patients' clinical charts. PD-1/PD-Ls expression in peripheral blood (PB) was detected using flow cytometry.

  Results: PD-1 was expressed at significantly lower levels on CD4+ or CD8+ peripheral T cells from patients with asbestosis and silicosis than on cells from healthy controls. Similarly, significantly lower PD-L1 and PD-L2 expression was detected on CD14+ monocytes from patients with asbestosis and silicosis than on cells from healthy controls. In addition, no significant differences in PD-1, PD-L1 and PD-L2 expression were observed between the asbestosis and silicosis groups. Moreover, the proportions of PD-1+ CD4+ T cells and PD-1+ CD8+ T cells in patients with asbestosis were positively correlated with the percentage of forced vital capacity predicted.

  Conclusions: Decreased PD-1 expression on CD4+ T or CD8+ T cells in PB was positively correlated with the asbestosis severity, implying that pulmonary fibrosis development in patients with asbestosis was positively correlated with the downregulation of the PD-1/PD-Ls pathway.

• Emerging avenues in immunotherapy for the management of malignant pleural mesothelioma. S.G. Gray. 2021;21(1):148. Review PubMed · Publisher · Free full text

  Abstract

  Background: The role of immunotherapy in cancer is now well-established, and therapeutic options such as checkpoint inhibitors are increasingly being approved in many cancers such as non-small cell lung cancer (NSCLC). Malignant pleural mesothelioma (MPM) is a rare orphan disease associated with prior exposure to asbestos, with a dismal prognosis. Evidence from clinical trials of checkpoint inhibitors in this rare disease, suggest that such therapies may play a role as a treatment option for a proportion of patients with this cancer.

  Main Text: While the majority of studies currently focus on the established checkpoint inhibitors (CTLA4 and PD1/PDL1), there are many other potential checkpoints that could also be targeted. In this review I provide a synopsis of current clinical trials of immunotherapies in MPM, explore potential candidate new avenues that may become future targets for immunotherapy and discuss aspects of immunotherapy that may affect the clinical outcomes of such therapies in this cancer.

  Conclusions: The current situation regarding checkpoint inhibitors in the management of MPM whilst encouraging, despite impressive durable responses, immune checkpoint inhibitors do not provide a long-term benefit to the majority of patients with cancer. Additional studies are therefore required to further delineate and improve our understanding of both checkpoint inhibitors and the immune system in MPM. Moreover, many new potential checkpoints have yet to be studied for their therapeutic potential in MPM. All these plus the existing checkpoint inhibitors will require the development of new biomarkers for patient stratification, response and also for predicting or monitoring the emergence of resistance to these agents in MPM patients. Other potential therapeutic avenues such CAR-T therapy or treatments like oncolytic viruses or agents that target the interferon pathway designed to recruit more immune cells to the tumor also hold great promise in this hard to treat cancer.

2010s

• Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust. V. Casillo, S. Cerri, A. Ciervo, et al. 2019;19(1):170. PubMed · Publisher · Free full text

  Abstract

  Background: Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. We evaluated clinical characteristics, respiratory function and prognostic predictors at diagnosis and at 12 month treatment of pirfenidone or nintedanib in IPF patients according to occupational dust exposure.

  Methods: A total of 115 IPF patients were recruited. At diagnosis, we collected demographic, clinical characteristics, occupational history. Pulmonary function tests were performed and two prognostic indices [Gender, Age, Physiology (GAP) and Composite Physiologic Index (CPI)] calculated, both at diagnosis and after the 12 month treatment. The date of long-term oxygen therapy (LTOT) initiation was recorded during the entire follow-up (mean = 37.85, range 12-60 months).

  Results: At baseline, patients exposed to occupational dust [≥ 10 years (n = 62)] showed a lower percentage of graduates (19.3% vs 54.7%; p = 0.04) and a higher percentage of asbestos exposure (46.8% vs 18.9%; p 0.002) than patients not exposed [< 10 years (n = 53)]. Both at diagnosis and after 12 months of antifibrotics, no significant differences for respiratory function and prognostic predictors were found. The multivariate analysis confirmed that occupational dust exposure did not affect neither FVC and DLCO after 12 month therapy nor the timing of LTOT initiation.

  Conclusion: Occupational dust exposure lasting 10 years or more does not seem to influence the therapeutic effects of antifibrotics and the prognostic predictors in patients with IPF.

• Possible value of antifibrotic drugs in patients with progressive fibrosing non-IPF interstitial lung diseases. S.E. Torrisi, N. Kahn, J. Wälscher, et al. 2019;19(1):213. PubMed · Publisher · Free full text

  Abstract

  Background: Fibrosing, non-idiopathic pulmonary fibrosis (non-IPF) interstitial lung diseases (fILDs) are a heterogeneous group of diseases characterized by a different amount of inflammation and fibrosis. Therapy is currently based on corticosteroids and/or immunomodulators. However, response to these therapies is highly variable, sometimes without meaningful improvement, especially in more fibrosing forms. Pirfenidone and nintedanib have recently demonstrated to reduce functional decline in patients with IPF. However, their antifibrotic mechanism makes these two drugs an interesting approach for treatment of fibrosing ILDs other than IPF.

  Objectives: We here report our experience with antifibrotic drugs in fibrosing non-IPF ILDs patients having a progressive phenotype during immunosuppressive therapy.

  Methods: Patients with a multidisciplinary team diagnosis of fibrosing non-IPF ILDs experiencing a progressive phenotype during treatment with corticosteroids and/or immunomodulators between October-2014 and January-2018 at our tertiary referral Center for ILDs were retrospectively analyzed. Antifibrotic therapy was administered after application with the respective health insurance company and after consent by the patient. Pulmonary-function-tests and follow-up visits were performed every 6 ± 1 months.

  Results: Eleven patients were treated with antifibrotic drugs (8 males, mean age 62 ± 12.8 years, mean FVC% 62.8 ± 22.3, mean DLCO% 35.5 ± 10.7, median follow-up under antifibrotic treatment 11.1 months). Patients had a diagnosis of unclassifiable ILD in 6 cases, pleuroparenchymal fibroelastosis in 2 cases, idiopathic-NSIP in 1 case, asbestos-related ILD in 1 case and Hermansky-Pudlak syndrome in 1 case. Treatment before antifibrotics consisted of corticosteroids in all patients: 5 combined with Azathioprin, 1 with either methotrexate or cyclophosphamide (i.v.). Ten patients were treated with pirfenidone (2403 mg/die) and 1 with nintedanib (300 mg/die). Median FVC was 56, 56, 50%, at time points - 24, - 12, - 6 before initiation, 44% at time of initiation and 46.5% at 6 months after initiation of antifibrotic treatment. Antifibrotic treatment was generally well tolerated with a need of dose reduction in 2 cases (rash and nausea) and early termination in 3 cases.

  Conclusions: Antifibrotic treatment may be a valuable treatment option in patients with progressive fibrosing non-IPF ILD if currently no other treatment options exist. However, prospective, randomized clinical trials are urgently needed to assess the real impact of antifibrotic therapy in these patients.

• Malignant pleural mesothelioma: diagnostic value of medical thoracoscopy and long-term prognostic analysis. L.L. Xu, Y. Yang, Z. Wang, et al. 2018;18(1):56. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant pleural mesothelioma (MPM) is marked by its difficult diagnosis and poor prognosis. Medical thoracoscopy (MT) is an effective and safe procedure for the diagnosis of exudative pleural effusions and many factors associated with poor prognosis of MPM. We conducted this study to investigate the value of MT for diagnosing of MPM and to identify prognostic factors for MPM patients.

  Methods: From July 2005 through June 2014, a total of 833 patients with undiagnosed pleural effusions underwent MT and pleural biopsies were taken. Clinical data of all patients with MPM were retrospectively analyzed, and those with complete follow-up data were analyzed for prognostic factors.

  Results: Eventually, MPM was the final diagnosis in 40 patients. Diagnostic efficiency of MT for MPM was 87.5%, since diagnosis of MPM failed to be established in 5 patients during the initial MT. Median survival was 17.1 mo (95% confidence interval: 13.6-20.7 mo). MT findings of pleural adhesion and plaques were adverse prognostic factors for MPM. In addition, old age, male gender, smoking history, histological type, poor staging, no treatment, low total protein level in pleural fluid, and computed tomographic findings such as pulmonary consolidation or infiltration, mediastinal lymphopathy, pulmonary mass or nodules, and pleural nodularity were also poor prognostic factors for MPM.

  Conclusions: MT is safe with a high positive rate in the diagnosis of MPM, and pleural adhesion and plaques seen under MT may be the adverse prognostic factors for MPM. Multiple clinical characteristics can affect the survival of MPM patients.

• Diagnostic value of medical thoracoscopy in malignant pleural effusion. Y.B. Wu, L.L. Xu, X.J. Wang, et al. 2017;17(1):109. PubMed · Publisher · Free full text

  Abstract

  Background: Medical thoracoscopy has been shown to be an efficacious procedure in diagnosing unexplained exudative pleural effusions with excellent safety. This study aimed to assess the diagnostic significance of thoracoscopy in the management of patients with malignant pleural effusion (MPE).

  Methods: Consecutive patients with malignant pleural effusion were retrospectively reviewed, and their demographic, radiographic, thoracoscopic and histological data were collected.

  Results: Between July 2005 and June 2014, 342 of 833 patients undergoing thoracoscopy were finally confirmed to suffer from MPE. The top three frequent causes of MPE were metastatic carcinoma (79.5%), malignant mesothelioma (10.2%), and lymphoma (2.9%). Among metastatic malignancies, the most common cancer was lung cancer (85.2%), followed by breast cancer (4.4%), ovarian cancer (2.2%), pancreatic cancer (1.8%), etc. No serious adverse events associated with thoracoscopy were recorded.

  Conclusions: Medical thoracoscopy is a valuable and safe tool in diagnosing malignant pleural effusion with minimal complication rates.

• Exploring efficacy and safety of oral Pirfenidone for progressive, non-IPF lung fibrosis (RELIEF) - a randomized, double-blind, placebo-controlled, parallel group, multi-center, phase II trial. J. Behr, P. Neuser, A. Prasse, et al. 2017;17(1):122. Randomized trial PubMed · Publisher · Free full text

  Abstract

  Background: Pirfenidone is currently approved in the EU for the treatment of mild to moderate idiopathic pulmonary fibrosis (IPF) and offers a beneficial risk-benefit profile. However, there are several other, progressive fibrotic lung diseases, in which conventional anti-inflammatory therapy is not sufficiently effective and antifibrotic therapies may offer a novel treatment option.

  Methods/Design: We designed a study protocol for inclusion of patients with progressive fibrotic lung disease despite conventional anti-inflammatory therapy (EudraCT 2014-000861-32). The study population comprises patients with collagen-vascular disease-associated lung fibrosis (CVD-LF), fibrotic non-specific interstitial pneumonia (fNSIP), chronic hypersensitivity pneumonitis (cHP), and asbestos-related lung fibrosis (ALF). Disease progression needs to be proven by slope calculation of at least three Forced Vital Capacity (FVC) values obtained within 6-24 months prior to inclusion, documenting an annualized decline in percent predicted FVC of 5% (absolute) or more despite appropriate conventional therapy. Absolute change in percent predicted FVC from baseline - analyzed using a rank analysis of covariance (ANCOVA) model - will serve as efficacy-related primary study endpoint.

  Discussion: There is an urgent unmet clinical need for effective therapies for patients with a progressive fibrotic lung disease other than IPF. The current study protocol is unique with respect to selecting patients with different disease entities of lung fibrosis which have, however, essential pathophysiological characteristics in common. Moreover, by selecting patients with evidence of disease progression despite conventional therapy, the protocol ensures that a cohort of interstitial lung disease (ILD) patients with a high unmet medical need is targeted and it may allow a sufficiently high event rate for evaluation of treatment responses.

  Trial Registration: DRKS00009822 (registration date: January 13th 2016).

• Pleural plaques in lung cancer screening by low-dose computed tomography: prevalence, association with lung cancer and mortality. M. Silva, N. Sverzellati, D. Colombi, et al. 2017;17(1):155. PubMed · Publisher · Free full text

  Abstract

  Background: To report the prevalence of pleural plaques in a lung cancer screening trial by low-dose computed tomography (LDCT) and to test the association with incidence of lung cancer and mortality.

  Methods: The LDCT of 2303 screenees were retrospectively reviewed with the specific aim of describing the prevalence and features of pleural plaques. Self-administered questionnaire was used to assess asbestos exposure. Frequency of lung cancer, lung cancer mortality, and overall mortality were detailed according to presence of pleural findings. Statistical analyses included comparison of mean or median, contingency tables, and Cox model for calculation of hazard ratio (HR) and its 95% confidence interval (CI).

  Results: Among male screenees, 31/1570 (2%) showed pleural abnormalities, 128/1570 (8.2%) disclosed asbestos exposure, 23/31 (74.2%) subjects with pleural plaques consistently denied exposure to asbestos. There was a trend for higher frequency of lung cancer among subjects with pleural plaques (9.7% vs 4.2%). Lung cancer in subjects with pleural plaques was always diagnosed in advanced stage. Subjects with pleural plaques showed HR 5.48 (95% CI 1.61-18.70) for mortality from lung cancer.

  Conclusions: Pleural plaques are a risk factor for lung cancer mortality that can be detected in lung cancer screening by LDCT, also in subjects that are not aware of asbestos exposure.

  Trial Registration: NCT02837809 - Retrospectively registered July 1, 2016 - Enrolment of first participant September 2005.

• Serum concentrations of Krebs von den Lungen-6, surfactant protein D, and matrix metalloproteinase-2 as diagnostic biomarkers in patients with asbestosis and silicosis: a case-control study. C. Xue, N. Wu, X. Li, et al. 2017;17(1):144. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestosis and silicosis are progressive pneumoconioses characterized by interstitial fibrosis following exposure to asbestos or silica dust. We evaluated the potential diagnostic biomarkers for these diseases.

  Methods: The serum concentrations of Krebs von den Lungen-6 (KL-6), surfactant protein D (SP-D), and matrix metalloproteinase-2 (MMP-2), MMP-7, and MMP-9 were measured in 43 patients with asbestosis, 45 patients with silicosis, 40 dust-exposed workers (DEWs) without pneumoconiosis, and 45 healthy controls (HCs). Chest high-resolution computed tomography (HRCT) images were reviewed by experts blinded to the clinical data. According to the receiver operating characteristic (ROC) curve, the ideal level of each biomarker and its diagnostic sensitivity were obtained.

  Results: The serum KL-6 and MMP-2 concentrations were highest in patients with asbestosis, particularly in comparison with those in DEWs and HCs (P<0.05). The serum SP-D concentration was significantly higher in patients with asbestosis than in patients with silicosis, DEWs, and HCs (P<0.01), whereas no significant difference was noted among patients with silicosis, DEWs, and HCs. No significant difference in the serum MMP-7 or -9 concentration was found among patients with asbestosis, patients with silicosis, DEWs, or HCs. Among patients with asbestosis, the serum KL-6 concentration was significantly correlated with the lung fibrosis scores on HRCT and negatively correlated with the forced vital capacity (FVC) % predicted and diffusing capacity of the lung for carbon monoxide (DLCO) % predicted. The serum SP-D and MMP-2 concentrations were negatively correlated with the DLCO % predicted (all P<0.05). The order of diagnostic accuracy according to the ROC curve was KL-6, SP-D, and MMP-2 in patients with asbestosis alone and in the combination of both patients with asbestosis and those with silicosis. The combination of all three biomarkers may increase the possibility of diagnosing asbestosis (sensitivity, 93%; specificity, 57%) and both asbestosis and silicosis (sensitivity, 83%; specificity, 62%).

  Conclusions: KL-6, SP-D, and MMP-2 are available biomarkers for the adjuvant diagnosis of asbestosis and silicosis. The combination of all three biomarkers may improve the diagnostic sensitivity for asbestosis and silicosis.

• The utility of electron microscopy in detecting asbestos fibers and particles in BALF in diffuse lung diseases. T. Kido, Y. Morimoto, K. Yatera, et al. 2017;17(1):71. PubMed · Publisher · Free full text

  Abstract

  Background: In patients with diffuse lung diseases, differentiating occupational lung diseases from other diseases is clinically important. However, the value of assessing asbestos and particles in bronchoalveolar lavage fluid (BALF) in diffuse lung diseases by electron microscopy (EM) remains unclear. We evaluated the utility of EM in detecting asbestos fibers and particles in patients with diffuse lung diseases.

  Methods: The BALF specimens of 107 patients with diffuse lung diseases were evaluated. First, detection of asbestos by EM and light microscopy (LM) were compared. Second, the detection of asbestos using surgically obtained lung tissues of 8 of 107 patients were compared with the results of EM and LM in BALF. Third, we compared the results of mineralogical components of particles in patients with (n = 48) and without (n = 59) a history of occupational exposure to inorganic dust.

  Results: BALF asbestos were detected in 11 of 48 patients with a history of occupational exposure by EM; whereas asbestos as asbestos bodies (ABs) were detected in BALF in 4 of these 11 patients by LM. Eight of 107 patients in whom lung tissue samples were surgically obtained, EM detected BALF asbestos at a level of >1,000 fibers/ml in all three patients who had ABs in lung tissue samples by LM at a level of >1,000 fibers/g. The BALF asbestos concentration by EM and in lung tissue by LM were positively correlated. The particle fractions of iron and phosphorus were increased in patients with a history of occupational exposure and both correlated with a history of occupational exposure by a multiple regression analysis.

  Conclusions: EM using BALF seemed to be superior to LM using BALF and displayed a similar sensitivity to LM using surgically-obtained lung tissue samples in the detection of asbestos. Our results also suggest that detection of elements, such as iron and phosphorus in particles, is useful for evaluating occupational exposure. We conclude that the detection of asbestos and iron and phosphorus in particles in BALF by EM is very useful for the evaluation of occupational exposure.

• Lung cancer risk test trial: study design, participant baseline characteristics, bronchoscopy safety, and establishment of a biospecimen repository. E.L. Crawford, A. Levin, F. Safi, et al. 2016;16:16. PubMed · Publisher · Free full text

  Abstract

  Background: The Lung Cancer Risk Test (LCRT) trial is a prospective cohort study comparing lung cancer incidence among persons with a positive or negative value for the LCRT, a 15 gene test measured in normal bronchial epithelial cells (NBEC). The purpose of this article is to describe the study design, primary endpoint, and safety; baseline characteristics of enrolled individuals; and establishment of a bio-specimen repository.

  Methods/Design: Eligible participants were aged 50-90 years, current or former smokers with 20 pack-years or more cigarette smoking history, free of lung cancer, and willing to undergo bronchoscopic brush biopsy for NBEC sample collection. NBEC, peripheral blood samples, baseline CT, and medical and demographic data were collected from each subject.

  Discussion: Over a two-year span (2010-2012), 403 subjects were enrolled at 12 sites. At baseline 384 subjects remained in study and mean age and smoking history were 62.9 years and 50.4 pack-years respectively, with 34% current smokers. Obstructive lung disease (FEV1/FVC <0.7) was present in 157 (54%). No severe adverse events were associated with bronchoscopic brushing. An NBEC and matched peripheral blood bio-specimen repository was established. The demographic composition of the enrolled group is representative of the population for which the LCRT is intended. Specifically, based on baseline population characteristics we expect lung cancer incidence in this cohort to be representative of the population eligible for low-dose Computed Tomography (LDCT) lung cancer screening. Collection of NBEC by bronchial brush biopsy/bronchoscopy was safe and well-tolerated in this population. These findings support the feasibility of testing LCRT clinical utility in this prospective study. If validated, the LCRT has the potential to significantly narrow the population of individuals requiring annual low-dose helical CT screening for early detection of lung cancer and delay the onset of screening for individuals with results indicating low lung cancer risk. For these individuals, the small risk incurred by undergoing once in a lifetime bronchoscopic sample collection for LCRT may be offset by a reduction in their CT-related risks. The LCRT biospecimen repository will enable additional studies of genetic basis for COPD and/or lung cancer risk.

  Trial Registration: The LCRT Study, NCT 01130285, was registered with Clinicaltrials.gov on May 24, 2010.

• Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation. C.C. Hak, P. Sivakumar, L. Ahmed. 2016;16:41. PubMed · Publisher · Free full text

  Abstract

  Background: Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study's objective is to determine if IPC insertion is safe in patients undergoing chemotherapy.

  Methods: We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications.

  Results: One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3%) vs 3 (4.9%) respectively, was not statistically different (Fisher's exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007).

  Conclusions: This is the second largest retrospective case-control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.

• Exercise training for asbestos-related and other dust-related respiratory diseases: a randomised controlled trial. M.T. Dale, Z.J. McKeough, P.A. Munoz, et al. 2014;14:180. Randomized trial PubMed · Publisher · Free full text

  Abstract

  Background: The study aimed to determine the short and long-term effects of exercise training on exercise capacity and health-related quality of life (HRQoL) compared to usual care in people with dust-related pleural and interstitial respiratory diseases. No previous studies have specifically evaluated exercise training in this patient population.

  Methods: Participants with a diagnosis of a dust-related respiratory disease including asbestosis and asbestos related pleural disease were recruited and randomised to an eight-week exercise training group (EG) or a control group (CG) of usual care. Six-minute walk distance (6MWD), St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Disease Questionnaire (CRQ) were measured at baseline, eight weeks and 26 weeks by an assessor blinded to group allocation.

  Results: Thirty-three of 35 male participants completed the study. Sixty-nine percent of participants had asbestos related pleural disease. At eight weeks, compared to the CG, the EG showed a significantly increased 6MWD (mean difference (95%CI)) 53 metres (32 to 74), improved SGRQ total score, -7 points (-13 to -1) and increased CRQ total score, 6.4 points (2.1 to 10.7). At 26 weeks significant between-group differences were maintained in 6MWD, 45 metres (17 to 73) and CRQ total score, 13.1 points (5.2 to 20.9).

  Conclusion: Exercise training improved short and long-term exercise capacity and HRQoL in people with dust-related pleural and interstitial respiratory diseases.

  Clinical Trial Registration Number: ANZCTR12608000147381. Date trial registered: 27.03.2008.

• Functional exercise capacity and health-related quality of life in people with asbestos related pleural disease: an observational study. M.T. Dale, Z.J. McKeough, P.A. Munoz, et al. 2013;13:1. PubMed · Publisher · Free full text

  Abstract

  Background: Functional exercise capacity in people with asbestos related pleural disease (ARPD) is unknown and there are no data on health-related quality of life (HRQoL). The primary aims were to determine whether functional exercise capacity and HRQoL were reduced in people with ARPD. The secondary aim was to determine whether functional exercise capacity was related to peak exercise capacity, HRQoL, physical activity or respiratory function.

  Methods: In participants with ARPD, exercise capacity was measured by the six-minute walk test (6MWT) and incremental cycle test (ICT); HRQoL by the St George's Respiratory Questionnaire and physical activity by an activity monitor worn for one week. Participants also underwent lung function testing.

  Results: 25 males completed the study with a mean (SD) age of 71 (6) years, FVC 82 (19)% predicted, FEV1/FVC 66 (11)%, TLC 80 (19)% predicted and DLCO 59 (13)% predicted. Participants had reduced exercise capacity demonstrated by six-minute walk distance (6MWD) of 76 (11)% predicted and peak work rate of 71 (21)% predicted. HRQoL was also reduced. The 6MWD correlated with peak work rate (r=0.58, p=0.002), St George's Respiratory Questionnaire Total score (r=-0.57, p=0.003), metabolic equivalents from the activity monitor (r=0.45, p<0.05), and FVC % predicted (r=0.52, p<0.01).

  Conclusions: People with ARPD have reduced exercise capacity and HRQoL. The 6MWT may be a useful surrogate measure of peak exercise capacity and physical activity levels in the absence of cardiopulmonary exercise testing and activity monitors.

  Trial Registration: ANZCTR12608000147381.

Browse every journal in the library or the library by type of article, or return to medical research.