Chia-Hung Chen

Background/Objectives: To develop and evaluate an automated CT-based framework for the quantitative assessment of fibrotic interstitial lung disease (ILD), including idiopathic pulmonary fibrosis (IPF), using a standardised six-level anatomical protocol and deep-learning lung segmentation. Methods: The segmentation dataset comprised 3315 manually annotated development slices from 92 patients and a non-overlapping internal holdout of 845 slices from 5 patients. A separate 100-study localisation/scoring set yielded a 97-patient agreement cohort (84 IPF, 13 other ILD; 1164 per-level, per-lung observations) after three DICOM-conversion exclusions. YOLO11n-seg masks underwent vessel- and structure-removal fibrosis detection. The radial spatial score was compared with a non-blind expert-adjudicated reference; the per-level Fibrosis Index was an auxiliary read-out. Results: On the five-patient internal segmentation holdout, mean intersection over union (mIoU) was 0.926 ± 0.017; the in-sample development value was approximately 0.95. Model-only latency was 73.8 ± 9.7 ms/slice at batch size 1, and peak throughput was 1.48 ms/slice at batch size 512. In the separate 97-patient agreement cohort, the expert-adjudicated score was identical to the automated score for 967 of 1164 observations (83.1%) and differed for 197 (16.9%). In the modified-score subset, Pearson r was 0.918, mean absolute error was 3.07, and ICC(2,1) was 0.889 (patient-clustered 95% CI 0.828–0.923). The pooled ICC(2,1) was 0.988 (0.982–0.992), but this value was inflated because the 967 unchanged pairs were identical by construction. Sequential end-to-end processing, measured in seven study patients, took a mean of 22.5 s per patient (median 24.0 s, range 17.3–24.9 s); localisation accounted for 88.1% of this time. Conclusions: The framework combined lung segmentation, anatomically standardised sampling, and automated fibrosis scoring. The radial score showed preliminary analytical concordance under non-blind expert adjudication. The fibrosis detector remains a proof-of-concept implementation based on 8-bit windowed images and has not been compared with independently drawn pixel-level fibrosis masks. The radial partition is an exploratory scoring convention and was not compared with alternative partitions or validated against clinical outcomes. Larger external studies using native Hounsfield-unit data and independent blinded readers are required.

Background: Small airway dysfunction (SAD) is a key component of asthma pathophysiology that may persist despite adequate treatment. Impulse oscillometry (IOS) provides sensitive detection of peripheral airway abnormalities beyond conventional spirometry. Fluticasone furoate/vilanterol (FF/VI) is a widely used once-daily inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA) combination that has been shown to improve lung function and reduce exacerbation risk in patients with asthma. However, the effects of FF/VI on small airway function have not been well explored, particularly using IOS and in relation to inflammatory phenotypes. Therefore, this study evaluated the effects of once-daily FF/VI on spirometry and IOS parameters and examined whether blood eosinophil levels influence these responses. Methods: Patients with asthma who received FF/VI for 12 months were retrospectively reviewed. Pulmonary function tests, including forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC), and IOS indices—resistance at 5 Hz (R5), resistance at 20 Hz (R20), the difference between R5 and R20 (R5–R20, kPa/L/s), reactance area (AX, kPa/L), and resonant frequency (Fres, Hz)—were compared before and after treatment. Patients were stratified according to blood eosinophil count (< 300 or ≥ 300 cells per microliter). Results: After one year of treatment, mean FEV₁ increased from 2.51 to 2.65 liters (p < 0.001) and mean FVC increased from 3.16 to 3.23 liters (p < 0.001). Total and central airway resistance decreased, with mean R5 declining from 148 to 131% of predicted (p < 0.001) and mean R20 from 145 to 134% of predicted (p < 0.001). The AX improved from 0.90 to 0.69 kPa/L (p = 0.044). However, significant improvements in R5–R20 and Fres were observed only among patients with blood eosinophil counts below 300 cells/μL. Conclusion: FF/VI 92/22 μg delivered via the Ellipta device significantly improved spirometric indices and central airway resistance. Improvements in small-airway mechanics were observed in patients with lower eosinophilic inflammation, suggesting that eosinophilic inflammation may be associated with attenuated small airway response. Further prospective studies are warranted to better define the role of inflammatory status in small airway dysfunction and to validate these findings.

Pulmonary alveolar proteinosis (PAP) is a rare, diffuse lung disease marked by the accumulation of PAS-positive proteinaceous material within distal airspaces. Diagnostic procedures include bronchoalveolar lavage, transbronchial lung biopsy (TBLB), and surgical lung biopsy (SLB). Recently, transbronchial lung cryobiopsy (TBLC) has emerged as a promising technique for diagnosing parenchymal lung diseases. This case series investigates the efficacy of TBLC in diagnosing PAP and compares it to traditional TBLB methods.

Background: Idiopathic pulmonary fibrosis (IPF) is a serious, progressive lung disease for which treatments are scarce. Pirfenidone has been approved for the treatment of IPF in Taiwan since 2016. This study aimed to gain a better insight into pirfenidone’s real-world safety and effectiveness in adult IPF patients in Taiwan. Methods: We conducted a prospective, multicenter, post-marketing surveillance study, and analyzed data from a small sample of 50 IPF patients treated with pirfenidone. Results: Most patients were men, with a mean age of 72.8 years (±10.3). They were in physiology stage I or II with a baseline mean forced vital capacity (FVC) of 2.236 L (73.8% of predicted value). After treatment with pirfenidone, the mean FVC decreased by 0.088 L at week 24 and 0.127 L at week 52. The mean 6 min walk test was 325.5 m at baseline, increased by 8.1 m at week 24, but then decreased by 23.0 m at week 52. These changes from baseline did not reach statistical significance. Pirfenidone prevented worsening of cough but did not stabilize dyspnea. During 52 weeks of treatment, the incidence of total adverse drug reactions was 62.0%, with decreased appetite (32.0%) and pruritis (10.0%) being the most common. The adverse events leading to treatment discontinuation were decreased appetite (8.0%), nausea (4.0%), and respiratory failure (4.0%). No safety concern was raised by the study. Treatment with pirfenidone stabilized both FVC and the subjective symptom of cough in most patients. Conclusions: This post-marketing surveillance study demonstrated that pirfenidone is an effective, safe, and well-tolerated treatment in patients with IPF in Taiwan.

Purpose: Self-expandable metallic stents (SEMSs) have enabled an approving management of malignant airway stenosis. However, benign tracheobronchial stenosis (BTBS) usually did not used the SEMS due to more complication. Balloon dilatation usually the first treatment choice but frequent recurrent is still the problem. Herin, we conducted this study to retrospectively determine the efficacy and safety between short-term SEMS placement and balloon dilatation for treated BTBS. Methods: There were 46 BTBS patients treated with SEMSs or balloon dilatation in China Medical University Hospital from Aug 2019 to Dec 2023 and were reviewed for outcome and complications. Results: Mean age was 69.1 years-old. The most common cause of BTBS was post intubation (n=23) and TB (n=15). 20 of them treated with balloon dilatation and 9 patients demonstrated clinical improvement without recurrent stenosis after 3 months follow-up. 26 patients were treated with SEMS placement followed by balloon dilatation and 22 patients demonstrated clinical improvement without recurrent stenosis after 3 months follow-up (45% vs 84.6 %, p value =0.001). 23 patients (88.5%) was successfdully removed by flexible bronchoscopy with forcerps. One patient suffered trachea laceration after balloon dilatation. Five patients suffered from stent infection after 3 months placement. There was no mortality after these procedure. Conclusions: The use of short term SEMSs after balloon dilatation for BTBS was effective and safe for the majority of benign tracheobronchial stenosis patients.

Previous studies have reported reduced acute exacerbation rates and improved symptom control in asthma patients treated using inhaled corticosteroids plus formoterol maintenance and reliever therapy (MART). Fluticasone furoate (FF) and vilanterol (VIL) also provide rapid bronchodilation and sustained anti-inflammatory effects, however no studies have investigated FF/VIL as MART for asthma control. From October 1, 2021 to September 30, 2023, this retrospective study included asthma patients classified as step 3 or 4 according to the Global Initiative for Asthma guidelines, who were then divided into two groups. One group received BUD/FOR as MART, while the other received FF/VIL as MART. Pulmonary function tests, exacerbation rates, Asthma Control Test (ACT), fractional exhaled nitric oxide (FeNO) levels, and blood eosinophil counts were measured before and after 12 months of treatment. A total of 161 patients were included, of whom 36 received BUD/FOR twice daily as MART, and 125 received FF/VIL once daily as MART. After 12 months of treatment, the FF/VIL group showed a significant increase in ACT scores by 1.57 (p < 0.001), while the BUD/FOR group had an increase of 0.88 (p = 0.11). In terms of FeNO levels, the BUD/FOR group experienced a decline of -0.2 ppb (p = 0.98), whereas the FF/VIL group had a mild increase of + 0.8 ppb (p = 0.7). Notably, there was a significant difference in the change of FeNO between the two groups (∆ FeNO: -0.2 ppb in BUD/FOR; + 0.8 ppb in FF/VIL, p < 0.001). There were no significant alterations observed in FEV1, blood eosinophil count, or acute exacerbation decline in either group. In the current study, patients treated with FF/VIL as MART showed improvements in ACT scores, while those treated with BUD/FOR as MART exhibited a reduction in FeNO levels. However, the difference between the two treatment groups did not reach clinical significance. Thus, FF/VIL as MART showed similar effectiveness to BUD/FOR as MART.

The objective was to compare the clinical efficacy of cefoperazone-sulbactam with piperacillin-tazobactam in the treatment of severe community-acquired pneumonia (SCAP). The retrospective study was conducted from March 1, 2018 to May 30, 2019. Clinical outcomes were compared for patients who received either cefoperazone-sulbactam or piperacillin-tazobactam in the treatment of SCAP. A total of 815 SCAP patients were enrolled. Among them, 343 received cefoperazone-sulbactam, and 472 received piperacillin-tazobactam. Patients who received cefoperazone-sulbactam presented with higher Charlson Comorbidity Index scores. (6.20 ± 2.77 vs 5.72 ± 2.61; P = .009). The clinical cure rates and effectiveness for patients receiving cefoperazone-sulbactam and piperacillin-tazobactam were 84.2% versus 80.3% (P = .367) and 85.4% versus 83.3% (P = .258), respectively. In addition, the overall mortality rate of the cefoperazone-sulbactam group was 16% (n = 55), which was also comparable to the piperacillin-tazobactam group (17.8%, n = 84, P = .572). The primary clinical outcomes for patients receiving cefoperazone-sulbactam were superior compared to those receiving piperacillin-tazobactam after adjusting disease severity status. The clinical efficacy of cefoperazone-sulbactam in the treatment of adult patients with SCAP is comparable to that of piperacillin-tazobactam. After adjusting for disease severity, cefoperazone-sulbactam tended to be superior to piperacillin-tazobactam.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, with approximately 70% to 80% of adults with COPD being undiagnosed. Patients with undiagnosed COPD are at increased risk of poor outcomes and a worsened quality of life, making early detection a crucial strategy to mitigate the impact of COPD and reduce the burden on healthcare systems. In the past decade, increased interest has been focused on the development of effective strategies and instrument for COPD early detection. However, identifying undiagnosed cases of COPD is still challenging. Both screening and case-finding approaches have been adopted to identify undiagnosed COPD, with case-finding being recommended by the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline and the updated United States Preventive Services Task Force (USPTF) recommendation. Nonetheless, the approaches, criteria, and instruments used for early detection of COPD are varied. However, advances in the taxonomy and risk factors of COPD are continuously being investigated. It is important to continuously assess the current state of knowledge on COPD early detection, given the challenges associated with identifying undiagnosed COPD. This review aims to highlight recent advances in early detection of COPD. To discuss the current challenge and opportunity in COPD early detection, providing an overview of existing literature on COPD case-finding strategies, including the approaches, criteria for subjects, and instruments. The review also summarizes the current progress in COPD case-findings and proposes a COPD case-finding flowchart as an efficient method for identifying at risk COPD patients.