Objective: Pulmonary rehabilitation programs, including exercise training, have an established role in the treatment of chronic respiratory diseases but are not routinely used in asthma. Most studies of individuals with asthma have focused on endurance training, and there is therefore limited data available on strength training. The aim of this study was to evaluate the effects that adding strength training to a program of endurance training and education has on the quality of life of such individuals. Methods: In this single-center, parallel-group randomized controlled trial, adults with moderate-to-severe asthma admitted for in-hospital pulmonary rehabilitation between June of 2021 and October of 2022 were randomized to either a study group (SG) or a control group (CG). The SG received strength training alongside endurance training and education, whereas the CG received the same endurance training and education, along with sham mobility exercise training instead of strength training. The primary outcome was the change in the Asthma Quality of Life Questionnaire (AQLQ) score from hospital admission to discharge. Results: A total of 61 participants were randomized, with 31 being assigned to the SG and 30 being assigned to the CG. At discharge, the AQLQ score showed significant improvement in both groups (p < 0.001 for the SG and p = 0.02 for the CG), albeit without a significant difference between the groups (p > 0.99). In contrast, peripheral muscle strength improved significantly from admission to discharge only in the SG, with a significant difference between the groups in terms of quadriceps strength (p = 0.03). Conclusions: Adding strength training to endurance training and education does not seem to result in further improvement in the quality of life of individuals with moderate-to-severe asthma.

Keywords: Rehabilitation; Asthma; Exercise therapy; Resistance training; Exercise tolerance; Quality of life. (ClinicalTrials.gov identifier: NCT04935125 [http://www.clinicaltrials.gov/])

Objective: To evaluate the prevalence of alpha-1 antitrypsin (AAT) variants through SERPINA1 genotyping in patients with non-cystic fibrosis bronchiectasis, and assess their clinical, functional and radiological characteristics. AAT deficiency is underdiagnosed, and an etiology to be considered when evaluating bronchiectasis. Methods: A cross-sectional study was conducted at an outpatient clinic focused on bronchiectasis in a tertiary hospital. Data from patients followed between 2005 and 2023 were collected. Genotyping for AAT was performed. Demographic, clinical, pulmonary function tests, serum AAT levels and chest CT data were analyzed. Results: A total of 136 patients were included, predominantly female (72.1%), with a median age of 56.6 years. The prevalence of SERPINA1 gene mutations was 25.7% (n=35). Among the detected variant genotypes were Pi*MS (15.4%), Pi*MZ (5,1%), Pi*SS (1,5%), Pi*ZZ (1,5%), Pi*MI (0,7%), Pi*SZ (0,7%) and Pi*ZMMalton (0,7%). When comparing patients with and without SERPINA1 mutations, significant differences were observed in AAT serum levels, emphysema type (panlobular) and distribution (diffuse and lower-lobe predominant). No other clinical, microbiological, functional or radiological differences were found, including emphysema presence or absence. Notably, 16 (45.7%) of individuals carrying SERPINA1 mutations exhibited normal serum AAT levels. Conclusions: AAT variants are not uncommon among patients with bronchiectasis. Presence of panlobular, diffuse or lower-lobe predominant emphysema should prompt AATD diagnostic consideration. However, the absence of emphysema does not exclude the diagnosis. Moreover, SERPINA1 variants may occur along with normal AAT serum levels. Clinicians should consider genotyping in patients with normal AAT levels, particularly when bronchiectasis remains unexplained.

Keywords: Alpha 1-antitrypsin deficiency; Bronchiectasis; Genotype; Mutation; Alleles

Objective: To develop and validate a portable volumetric capnograph for collecting data on ventilatory mechanics during spontaneous breathing for outpatient use. Methods: The device was developed by integrating the following commercially available sensors: a Hamilton® flow sensor (variable orifice; Hamilton Medical AG, Graubünden, Switzerland); an SDP810-125PA differential pressure sensor (Sensirion AG, Stäfa, Switzerland); and a Capnostat 5 CO2 sensor (Philips Respironics, Murrysville, PA, USA). An Arduino UNO-R3® microcontroller (Arduino, Monza, Italy) was used as an interface between the sensors and a laptop computer, and a Python application was used to acquire data at 10 ms intervals (100 Hz). Validation included static tests (flow: 0-45 L/min; partial pressure of CO2: 0-100 mmHg) and tests with five healthy volunteers (n = 115 respiratory cycles), in comparison with the reference equipment (a CO2SMO Plus® DX-8100 oxycapnograph; Philips Respironics). Results: The static tests showed excellent linear correlation for flow and CO2 concentration. For the tests conducted with the five volunteers, no significant differences were observed between the portable volumetric capnograph and the reference equipment for any of the variables analyzed. Intracycle variability was observed in the capnography curves, reflecting the physiological characteristics of spontaneous breathing. Conclusions: Our portable volumetric capnograph demonstrated the ability to collect accurate data on flow and partial pressure of CO2 during spontaneous breathing, with performance equivalent to that of the reference equipment. The variability in the capnography curves represents an intrinsic characteristic of spontaneous breathing that must be considered when developing algorithms for calculating physiological indicators.

Keywords: Volumetric capnography, microcontroller, respiratory monitoring, spontaneous breathing, portable device.

Objective: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, being characterized by persistent obstruction of pulmonary vessels and leading to increased pulmonary vascular resistance and right ventricular failure. Although pulmonary endarterectomy is the preferred treatment, medical therapies may offer clinical benefits in specific settings. We sought to evaluate the clinical and hemodynamic response of CTEPH patients treated with sildenafil and ambrisentan upfront combination therapy. Methods: This was a retrospective cohort study including patients with operable and inoperable CTEPH. The patients were followed from 2019 to 2022 and were treated with sildenafil and ambrisentan as first-line therapy. Results: Functional and hemodynamic data were analyzed at baseline and after a minimum of six months of therapy. Following treatment, there was a notable improvement in functional class, natriuretic peptide levels, and invasive hemodynamics. Conclusions: The combined use of sildenafil and ambrisentan appears to be associated with clinical, functional, and hemodynamic improvement in patients with CTEPH.

Keywords: Pulmonary Embolism; Drug therapy, combination; Hypertension, pulmonary.

Objective: Although communicating air pollution risks is critical for protecting public health, particularly in low- and middle-income countries (LMICs), its effectiveness remains underexplored. This study evaluated current risk communication practices in the city of Rio de Janeiro, Brazil, by assessing the associations between short-term exposure to pollutants and respiratory-related hospital admissions; the ability of the Brazilian national índice de qualidade do ar (IQAr, air quality index) to reflect health risks; and the accuracy of pollutant forecasts in comparison with monitored concentrations. Methods: Exposure and health data for the 2014-2019 period were obtained through a research partnership with local government officials. Poisson generalized linear models were employed to determine whether IQAr values and short-term exposure to air pollutants, including nitrogen dioxide (NO2) and particulate matter (PM), were associated with daily hospital admissions for respiratory disease. Bias-corrected, forecasted daily concentrations of individual air pollutants from the Goddard Earth Observing System Composition Forecast Composition Forecast (GEOS-CF) model were employed to assess the performance of existing forecasting tools for use in risk communication. Results: Significant associations were consistently observed between hospital admissions for respiratory disease and short-term exposures to NO2 and coarse PM, with excess risks of 5.1% (95% CI: 1.3-8.9%) and 5.6% (95% CI: 1.5-9.9%), respectively, per interquartile range increases in lag day 0-1 exposures. Values of IQAr were not significantly associated with respiratory health events, likely due to their failure to capture the health risks associated with NO2. Bias-corrected forecasts from the GEOS-CF model showed strong correlations with observed pollutant concentrations. Conclusions: These findings indicate that adopting a health-based, multi-pollutant index, combined with improved forecasting tools, could substantially strengthen risk communication in the city of Rio de Janeiro and other LMIC settings.

Keywords: Air pollutants/analysis; Air pollution/adverse effects; Nitrogen dioxide; Particulate matter; Developing countries; Respiratory tract diseases/epidemiology.

Objective: Preventive treatment of active tuberculosis is one of the main strategies for reducing the incidence of tuberculosis. We sought to evaluate the rates of latent tuberculosis infection (LTBI) treatment completion with three months of once-weekly isoniazid plus rifapentine (3HP) and compare them with those for six to nine months of daily isoniazid (6H/9H). Methods: This was a retrospective cross-sectional study. Consecutive patients undergoing LTBI treatment with 3HP or 6H/9H were included in the study. Treatment completion rates and adverse effects were analyzed. Results: A total of 226 patients were included in the study: 113 in the 3HP group and 113 in the 6H/9H group. The frequency of adverse effects was not significantly different between the 3HP and 6H/9H groups. The 3HP group had a higher treatment completion rate (93.8%) than did the 6H/9H group (84.1%), the difference being significant. Conclusions: The rates of LTBI treatment completion appear to be higher with 3HP than with 6H/9H. Health care professionals should be vigilant in managing adverse effects to further maximize LTBI treatment completion.

Keywords: Tuberculosis, pulmonary; Latent tuberculosis/prevention & control; Mycobacterium tuberculosis.

Objective: To compare the former tuberculosis treatment regimen including one fluoroquinolone (ofloxacin, levofloxacin, or moxifloxacin) and a second-line injectable drug (amikacin, kanamycin, or capreomycin) plus three to five oral drugs (regimen 1) with the current regimen including the three WHO group A drugs (regimen 2) in terms of efficacy and safety at two tuberculosis referral centers in Mexico. Methods: This was a retrospective study based on a review of the clinical records of all consecutive rifampin-resistant or multidrug-resistant tuberculosis (RR/MDR-TB) patients treated from January of 2010 to October of 2023. Patients included were microbiologically confirmed cases of RR/MDR-TB with pulmonary involvement and who received at least 30 days of regimen 1 or regimen 2. Outcomes and adverse events were classified in accordance with WHO definitions. Results: One hundred and twenty-six RR/MDR-TB patients met the inclusion criteria. Of those, 87 were treated with regimen 1 and 39 received regimen 2. Success rates were not significantly different between the two groups of patients, although those treated with the oral regimen including bedaquiline from regimen 2 had higher success rates. Regimen 2 patients experienced a shorter time to culture conversion, and the regimen length was shortened accordingly, the median duration being 16.1 months [IQR, 15-17.3 months]. In patients receiving the all-oral regimen 2, adverse events were significantly associated with a history of type 2 diabetes mellitus (OR = 15.4; 95% CI, 2.73-87.29; p = 0.002) and were mainly related to linezolid use. Conclusions: Oral regimens appear to be effective, although toxicity to linezolid requires strict patient monitoring.

Keywords: Mexico; Tuberculosis, multidrug-resistant; Bedaquiline; Linezolid; Treatment outcome.

Objective: Fungal pulmonary infections are a significant complication in lung cancer, adversely affecting prognosis and treatment outcomes. This meta-analysis aimed to estimate the prevalence of chronic pulmonary aspergillosis (CPA) and Pneumocystis jirovecii pneumonia (PJP) in lung cancer patients and to identify associated clinical predictors. Methods: A systematic search of EBSCOhost, Embase, PubMed/MEDLINE, Scopus, and Web of Science retrieved 2,823 records, of which 7 studies were eligible (PROSPERO: CRD42024551104). Meta-analyses of proportions and dichotomous and continuous variables were performed using R (meta package) via Jamovi and RevMan 5, with statistical significance set at p<0.05. Results: Among 15,901 lung cancer patients, 177 had CPA and 135 had PJP. The pooled prevalence was 1% for CPA and 23% for PJP. CPA was significantly associated with male sex, smoking, COPD, interstitial lung disease, tuberculosis, and squamous cell carcinoma, and negatively associated with adenocarcinoma. CPA patients also had significantly lower BMI. Bilobectomy, radiotherapy, and concurrent chemoradiotherapy were additional risk factors for CPA. High-dose corticosteroid use (=20 mg/day) was significantly associated with PJP. Conclusion: CPA occurs in a clinically distinct subset of lung cancer patients with identifiable risk factors, while PJP appears to be strongly linked to immunosuppressive therapy. Improved screening strategies are warranted to mitigate the burden of these infections in vulnerable lung cancer populations.

Keywords: lung cancer; fungal infection; pulmonary infection; aspergillosis; Pneumocystis jirovecii; pneumonia.