Pulmonology

Baseline DLco strongly predicts post-intervention benefit and outcomes in CTEPH

In this Japanese nationwide CTEPH registry, lower baseline DLco predicted smaller improvements in mean PAP, PVR, and cardiac index after pulmonary endarterectomy or BPA. Reduced DLco was also associated with a higher risk of clinical events, with a reported hazard ratio of 0.971 per unit increase. Outcomes deteriorated below a DLco of 59.6%, suggesting this threshold identifies patients with more advanced microvasculopathy. Baseline DLco can therefore aid prognostic counseling and expectations about hemodynamic gain from CTEPH interventions. 1

Admission eosinopenia ≤30/µL predicts respiratory failure in CAP

In this prospective multicentre CAP cohort, an admission eosinophil count ≤30/µL optimally predicted need for mechanical ventilation. Patients with eosinopenia had roughly double the mechanical ventilation rate compared with higher counts, independent of glucocorticoid use. They also had higher ICU admission rates and slightly longer hospital stays among survivors. A simple admission eosinophil cutoff (≤30/µL) may refine early triage, monitoring intensity, and escalation thresholds in hospitalized CAP. 2

Serum NOTCH3-ECD is a high-performance biomarker for idiopathic PAH

Across three cohorts, serum NOTCH3-ECD levels were markedly higher in IPAH patients than healthy controls and correlated with multiple hemodynamic and functional indices. A diagnostic cutoff of 13.0 ng/ml yielded an AUC of 0.96 with ~90% sensitivity and 93% specificity for IPAH. Higher NOTCH3-ECD above this cutoff was associated with increased 3-year mortality risk and tracked disease progression over six years. Adding NOTCH3-ECD improved performance of existing PAH prognostic calculators, suggesting potential value for noninvasive diagnosis and longitudinal risk assessment. 3

Global burden of chronic respiratory disease remains high despite declining death rates

Using GBD 2023 data, chronic respiratory diseases caused an estimated 569.2 million cases and 4.2 million deaths worldwide in 2023. Age-standardized mortality fell by about one-quarter since 1990, despite rising ILD and sarcoidosis burden, especially in older adults. Asthma mortality declined notably in younger males, while ILD and pulmonary sarcoidosis mortality increased in older populations. Smoking remained the primary risk factor for COPD, whereas high BMI and silica exposure were key for asthma and pneumoconiosis. During the COVID-19 pandemic, incidence modestly increased but mortality declines accelerated, underscoring ongoing need for prevention and risk-factor control. 4