Respiratory Diseases
Summary
Respiratory diseases encompass a wide spectrum of disorders that impair the airways, lung parenchyma or pulmonary circulation. Common chronic conditions include asthma—characterised by type-2 inflammation, airway hyperresponsiveness and reversible obstruction—and chronic obstructive pulmonary disease (COPD), marked by progressive, irreversible airflow limitation, emphysema and small-airway remodelling. Interstitial lung diseases involve diffuse fibrosis and inflammation of the interstitium, while cystic fibrosis stems from a genetic ion-channel defect leading to thickened secretions, recurrent infection and bronchiectasis. Acute infections such as pneumonia and tuberculosis remain major causes of global morbidity and mortality, and lung cancer is the leading fatal malignancy worldwide. Shared pathogenic mechanisms—dysregulated immune responses, epithelial injury, oxidative stress and protease–antiprotease imbalance—drive many of these conditions, which collectively account for millions of deaths each year and impose enormous socio-economic burdens.
Research from Nature Portfolio
Machine-learning algorithms have been shown to forecast imminent respiratory failure and the need for invasive mechanical ventilation in critically ill patients, including those with COVID-19. By analysing time-series data of vital signs and laboratory results, models based on XGBoost achieved areas under the curve of up to 0.94 for predicting intubation 6–24 hours in advance, offering a tool to guide clinical decision-making. In parallel, comparative studies of the ROX index and the HACOR scale in patients with SARS-CoV-2 pneumonia demonstrated that both scores—integrating respiratory rate, oxygenation and other parameters—have moderate predictive accuracy (AUC≈0.71–0.72) for high-flow nasal cannula failure, aiding timely escalation to invasive support.
Respiratory Diseases publication trend
The graph below shows the total number of articles in respiratory diseases across all publications each year (not limited to Nature Index journals).
Technical terms
Airway hyperresponsiveness: Exaggerated bronchoconstriction in response to stimuli, a hallmark of asthma.
Forced expiratory volume/forced vital capacity ratio (FEV1/FVC): Spirometric index of airflow obstruction; COPD defined when FEV1/FVC <0.70 post-bronchodilator.
High-flow nasal cannula (HFNC): Oxygen delivery system providing heated, humidified gas at high flows (up to 60 L/min), generating low-level positive airway pressure.
ROX index: The ratio of SpO2/FiO2 to respiratory rate, used to predict HFNC success or failure.
HACOR scale: Composite score (Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory rate) to assess noninvasive ventilation or HFNC failure risk.
Alveolar fluid clearance (AFC): Active removal of protein-rich oedema fluid from alveoli via epithelial sodium transport, critical for resolving pulmonary oedema.
Interleukin-5 (IL-5): Cytokine that drives eosinophil maturation, activation and survival, central to eosinophilic asthma pathogenesis.
Bayesian network meta-analysis: Statistical method that compares multiple interventions across trials, estimating relative efficacy and safety probabilities.
References
- Introduction to Lung Diseases.
- High-flow nasal cannula oxygen therapy in adults. Journal of Intensive Care (2015).
- Transnasal humidified rapid insufflation ventilatory exchange vs. facemask oxygenation in elderly patients undergoing general anaesthesia: a randomized controlled trial. Scientific Reports (2020).
- Comparison of ROX and HACOR scales to predict high-flow nasal cannula failure in patients with SARS-CoV-2 pneumonia. Scientific Reports (2021).
- Efficacy and safety of antibiotics targeting Gram-negative bacteria in nosocomial pneumonia: a systematic review and Bayesian network meta-analysis. Annals of Intensive Care (2024).
- IL-5 antagonism reverses priming and activation of eosinophils in severe eosinophilic asthma. Mucosal Immunology (2024).
- Epithelial-Mesenchymal Transition in Asthma Airway Remodeling Is Regulated by the IL-33/CD146 Axis. Frontiers in Immunology (2020).
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