Hyonsoo Joo

Background: The Rapid Cough Questionnaire (RCQ) is a simplified three-item instrument developed as a pragmatic alternative to the Leicester Cough Questionnaire (LCQ). However, its performance across diverse respiratory diseases, particularly structural lung diseases, has not been sufficiently validated. This study evaluated the performance of the RCQ across major respiratory disease subgroups. Methods: A total of 300 adult patients with chronic cough were prospectively enrolled from multiple respiratory centres. Participants completed five cough-specific instruments: Numeric Rating Scale (NRS), Cough Symptom Score (CSS), COugh Assessment Test (COAT), LCQ and RCQ. Construct validity was evaluated using correlation analyses across disease subgroups, including chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis (IPF) and bronchiectasis. Results: The RCQ showed strong correlations with the LCQ (r=0.93), COAT (r=−0.75), CSS (r=−0.62) and NRS (r=−0.59). These relationships remained robust among all aetiologies, with the correlation coefficients between RCQ and LCQ exceeding 0.88 in each subgroup. Bland-Altman plots and an intraclass correlation analysis indicated a high level of concordance between the RCQ and LCQ scores. The RCQ aligned closely with multidimensional symptom burden and maintained strong correlation with the LCQ even for IPF, where LCQ correlations with unidimensional tools (NRS or CSS) were attenuated. Conclusions: The RCQ demonstrated strong cross-sectional concordance with the LCQ across heterogeneous respiratory conditions. Its brevity and consistent performance support its suitability in routine clinical practice and large-scale or longitudinal research settings. Further studies are warranted to evaluate its responsiveness and longitudinal performance.

Background and Objective: Ambient air pollution is known to exacerbate respiratory illnesses. However, its impact on COVID‐19 outcomes remains underexplored. We investigated the association between ambient air pollution and outcomes in patients with moderate to severe COVID‐19. Methods: We analysed 1867 hospitalized patients from a multicentre Korean cohort. Individual‐level exposure to five air pollutants (SO ₂ , CO, NO ₂ , PM ₁₀ and PM _2.5 ) was assessed over short‐term (3‐day) and long‐term (3‐year) periods. The risks of acute respiratory distress syndrome (ARDS) and 30‐day mortality were evaluated using models adjusted for clinical and meteorological factors. Pollutant exposure was analysed both as quartiles and continuous variables to estimate effects per unit increase. Results: Short‐term CO exposure was associated with increased ARDS incidence (per 0.1 ppm increase OR 1.18) and 30‐day mortality (HR 1.15). Long‐term NO ₂ exposure was associated with higher ARDS risk (per 1 ppb OR 1.11). Long‐term PM ₁₀ exposure was also associated with ARDS incidence (per 10 μg/m ³ OR 2.24). For mortality, short‐term NO ₂ (per 1 ppb HR 1.02) and PM _2.5 (per 10 μg/m ³ HR 1.14) exposure were additionally associated with increased risk. These associations were consistent in quartile‐based analyses. Conclusion: Both short‐ and long‐term exposure to ambient air pollution were associated with worse COVID‐19 outcomes, including ARDS and mortality. CO, often overlooked in pollution surveillance, showed the most consistent impact. These findings highlight the importance of air quality in pandemic preparedness and public health policy. image

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation and persistent respiratory symptoms. A key factor in the progression of COPD is small airway dysfunction (SAD), which originates in airways smaller than 2 mm in diameter. Chronic exposure to smoke and toxins leads to inflammatory remodeling and luminal obstruction, detectable through micro-computed tomography (CT) studies before spirometric airflow limitations become evident. SAD exacerbates COPD by increasing airway resistance and promoting dynamic airway collapse during exhalation. Clinically, SAD presents as gas trapping, hyperinflation, and exercise intolerance, which are associated with a rapid decline in lung function. Recent evidence indicates that SAD may be a modifiable and clinically significant trait in COPD, with management strategies including extrafine-particle inhalers, smoking cessation, pulmonary rehabilitation, and emerging biologic therapies. Various assessment methods, such as pulmonary function tests and CT imaging, are used to assess SAD. This review focuses on the role of SAD in the pathophysiology of COPD and the clinical implications of easily applicable measurements, including forced expiratory flow between 25% and 75% of forced vital capacity, impulse oscillometry, Pi10, and parametric response mapping, as well as potential treatment modalities for SAD in COPD.

Joo H, et al. J Korean Med Sci. 2026 Jun;41(24):e187. https://doi.org/10.3346/jkms.2026.41.e187

Kang J, et al. J Korean Med Sci. 2024 Aug;39:e273. https://doi.org/10.3346/jkms.2024.39.e273

Background: Neutropenia, which is characterized by a low count of neutrophils, plays a critical role in the pathophysiology of acute respiratory distress syndrome and acute lung injury. It is a commonly expected event in numerous cancer patients who receive chemotherapy. Galantamine is a competitive and reversible cholinesterase inhibitor used in the treatment of Alzheimer9s disease and other conditions that cause memory impairment. Recent studies showed that galantamine reduced the severity of local inflammation in animals, inhibited the degree of systemic inflammatory response induced by LPS (lipopolysaccharide), and suppressed TNF-alpha expression in rats with LPS-induced peritonitis. The aim of this study was to elucidate whether galantamine is effective in LPS-induced ALI during neutropenia recovery in a murine model. Methods: Intraperitoneal cyclophosphamide was given to all mice to induce neutropenia. 2 days after, mice were administered LPS by intratracheal instillation. In the first preventive group, galantamine was given by intraperitoneal injection 30 minutes before LPS instillation. In the second preventive group, in order to examine dose-cumulative effect, galantamine was given twice- 5hours and 30minutes before LPS. In the treatment group, galantamine was given 6 hours after LPS. Mice were sacrificed 24 hours after LPS. Results: Galantamine ameliorated histopathological changes in LPS-induced lung injury. In prevention 2 group, when galantamine was given twice before LPS instillation had most effect in terms of inflammation attenuation.(figure) Conclusion: The present study demonstrated that galantamine attenuated LPS-induced lung injury during neutropenia recovery.

Background: Community-acquired pneumonia (CAP) is a major health concern and the leading cause of death among infectious diseases, with significant implications for healthcare systems worldwide. Poor outcomes are typically attributed to the severity of the infection, as well as patient characteristics and co-morbidities. CURB-65 is used to assess the severity of CAP. The aim of this study is to compare the in-hospital mortality rates by different CURB type severity scores. Methods: We used the Quality Assessment(QA) Research Database for Pneumonia in Korea. The QA database included the data reported from the three rounds of QA. The patients who met the criteria of hospitalized CAP were enrolled. Results: Total 54,307 patients from QA database were screened, and 44,099 of them were included in the study. The average age of the patients was 64.6 years, and 47.5% were male. The hospital length of stay was an average of 8.9±6.1 days, and patients were treated with antibiotics for an average of 8.3±5.3 days. Overall, the in-hospital mortality rate was 3.0% (1,308 patients). Table 1 shows the distribution of patients across different severity scores for four different pneumonia severity assessment tools: CURB-65, CRB-65, CURB, and CRB. The results show that patients with higher severity scores had a higher risk of mortality, as expected. Among the four assessment tools, CURB-65 has the highest AUROC value (0.829), followed by CURB (0.797). Conclusion: In the three severity scores created by simplifying the curb-65 items, when the score increased, the mortality rate also increased. However, CURB-65 has the highest predictive accuracy for in-hospital mortality among the severity assessment tools.