Smoking inhibits the frequency of bronchovascular bundle thickening in sarcoidosis

Tobacco smoking and sarcoidosis revisited-Evidence, mechanisms, and clinical implications: a narrative review

Sarcoidosis is a multisystem inflammatory disease with unclear etiology, influenced by genetic predisposition and environmental exposures. Smoking has been widely studied for its potential role in sarcoidosis, with conflicting evidence regarding its impact on disease risk, severity, and treatment response. While some epidemiologic studies suggest that smoking is associated with a lower risk of sarcoidosis, others highlight variations based on geography, ethnicity, and smoking history. Assessing the effects of smoking is particularly challenging because of the complex composition of tobacco smoke, which contains thousands of chemicals with diverse biologic effects. Nicotine, a major component of tobacco, has demonstrated both pro- and anti-inflammatory properties, further complicating its role in sarcoidosis. This narrative review explored the complex relationship between smoking and sarcoidosis by examining smoking's effects on immune modulation, disease presentation and prognosis, and response to immunosuppressive therapy. By summarizing current evidence, this paper aimed to clarify the impact of smoking and nicotine on sarcoidosis and identify key areas for future research, particularly in understanding the mechanisms underlying smoking-related immune modulation and treatment outcomes.

CT Differentiation and Prognostic Modeling in COVID-19 and Influenza A Pneumonia

RATIONALE AND OBJECTIVES

This study aimed to compare CT features of COVID-19 and Influenza A pneumonia, develop a diagnostic differential model, and explore a prognostic model for lesion resolution.

MATERIALS AND METHODS

A total of 446 patients diagnosed with COVID-19 and 80 with Influenza A pneumonitis underwent baseline chest CT evaluation. Logistic regression analysis was conducted after multivariate analysis and the results were presented as nomograms. Machine learning models were also evaluated for their diagnostic performance. Prognostic factors for lesion resolution were analyzed using Cox regression after excluding patients who were lost to follow-up, with a nomogram being created.

RESULTS

COVID-19 patients showed more features such as thickening of bronchovascular bundles, crazy paving sign and traction bronchiectasis. Influenza A patients exhibited more features such as consolidation, coarse banding and pleural effusion (P < 0.05). The logistic regression model achieved AUC values of 0.937 (training) and 0.931 (validation). Machine learning models exhibited area under the curve values ranging from 0.8486 to 0.9017. COVID-19 patients showed better lesion resolution. Independent prognostic factors for resolution at baseline included age, sex, lesion distribution, morphology, coarse banding, and widening of the main pulmonary artery.

CONCLUSION

Distinct imaging features can differentiate COVID-19 from Influenza A pneumonia. The logistic discriminative model and each machine - learning network model constructed in this study demonstrated efficacy. The nomogram for the logistic discriminative model exhibited high utility. Patients with COVID-19 may exhibit a better resolution of lesions. Certain baseline characteristics may act as independent prognostic factors for complete resolution of lesions.

Potential therapeutic targets to prevent organ damage in chronic pulmonary sarcoidosis

INTRODUCTION

Sarcoidosis is a granulomatous inflammatory disease with high chances of reduced quality of life, irreversible organ damage, and reduced life expectancy when vital organs are involved. Any organ system can be affected, and the lungs are most often affected. There is no preventive strategy as the exact etiology is unknown, and complex immunogenetic and environmental factors determine disease susceptibility and phenotype. Present-day treatment options originated from clinical practice and are effective in many patients. However, a substantial percentage of patients suffer from unacceptable side effects or still develop refractory, threatening pulmonary or extrapulmonary disease.

AREAS COVERED

As non-caseating granulomas, the pathological hallmark of disease, are assigned to divergent activation and regulation of the immune system, targets in relation to the possible triggers of granuloma formation and their sequelae were searched and reviewed.

EXPERT OPINION

:The immunopathogenesis underlying sarcoidosis has been a dynamic field of study. Several recent new insights give way to promising new therapeutic targets, such as certain antigenic triggers (e.g. from Aspergillus nidulans), mTOR, JAK-STAT and PPARγ pathways, the NRP2 receptor and MMP-12, which await further exploration. Clinical and trigger related phenotyping, and molecular endotyping in sarcoidosis will likely hold the key for precision medicine in the future.

Defining CD4 T helper and T regulatory cell endotypes of progressive and remitting pulmonary sarcoidosis (BRITE): protocol for a US-based, multicentre, longitudinal observational bronchoscopy study

INTRODUCTION

Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene-environment interactions. Sarcoidosis affects 45-300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.

METHODS AND ANALYSIS

The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.

Bronchovascular bundle thickening on CT as a predictor of survival and brain metastasis in patients with stage IA peripheral small cell lung cancer

AIM

To determine if bronchovascular bundle (BVB) thickening on pretreatment computed tomography (CT) images helps predict survival in patients with peripheral small cell lung cancer (pSCLC) ≤3 cm.

MATERIALS AND METHODS

The pretreatment CT examinations of 79 histopathologically proven pSCLC ≤3 cm (TNM stage I, 21; II, 13; III, 22; IV, 23) were reviewed retrospectively. The CT characteristics of the nodule and associated findings, including BVB thickening, were evaluated. Progression-free survival (PFS), overall survival (OS), and brain metastasis-free survival were compared with the presence of BVB thickening using Kaplan-Meier and Cox regression analysis.

RESULTS

Among the 79 patients, 34 (43%) had BVB thickening. BVB thickening was prevalent in patients with mediastinal lymph node metastasis (50.9% versus 22.7%; p=0.024) and distant metastasis (60.9% versus 35.7%; p=0.049). Out of the 21 patients with TNM stage IA disease, the 16 patients (76.2%) without BVB thickening showed better PFS, OS, and brain metastasis-free survival (mean, 1,762 versus 483 days; p=0.019: 2,243 versus 1,328 days; p=0.038: 2,274 versus 1,287 days; p=0.038, respectively). Multivariate Cox regression analysis showed that the absence of BVB thickening (hazard ratio [HR], 7.806; 95% CI, 1.241-49.091; p=0.029) and surgery (HR, 0.075; 95% CI, 0.008-0.746; p=0.027) were independent and useful prognostic factors for PFS.

CONCLUSIONS

BVB thickening was found more frequently in patients with advanced-stage pSCLC ≤3 cm, and the PFS was more favourable in patients without BVB thickening, with a similar tendency to that of OS and brain metastasis-free survival, in stage IA pSCLC.

Genetics of Sarcoidosis

Sarcoidosis is a disease with highly variable presentation and progression; although it is hypothesized that disease phenotype is related to genetic variation, how much of this variability is driven by genetic factors is not known. The HLA region is the most strongly and consistently associated genetic risk factor for sarcoidosis, supporting the notion that sarcoidosis is an exposure-mediated immunologic disease. Most of the genetic etiology of sarcoidosis remains unknown in terms of the specific variants that increase risk in various populations, their biologic functions, and how they interact with environmental exposures.

Cigarette smoking and male sex are independent and age concomitant risk factors for the development of ocular sarcoidosis in a New Orleans sarcoidosis population

INTRODUCTION

Sarcoidosis is a multi-organ system granulomatous disease of unknown origin with an incidence of 1-40/100,000. Though pulmonary manifestations are predominant, ocular sarcoidosis (OS) affects 25-50% of patients with sarcoidosis and can lead to blindness.

METHODS

A retrospective, single-center chart review of sarcoidosis cases investigated variables associated with the development of OS. Inclusion criteria were biopsy-proven sarcoidosis, disease duration greater than 1 year, documented smoking status on chart review and documentation of sarcoid-related eye disease. Multivariate analysis identified independent risk factors for OS.

RESULTS

Of 269 charts reviewed, 109 patients met inclusion criteria. The OS group had a significantly higher proportion of smokers (71.4%) than without OS (42.0%, p=0.027) with no difference (p=0.61) in median number of pack years. Male sex was significantly higher in the OS group (57.1% versus 26.1%, p=0.009). Median duration of sarcoidosis was higher in the OS group (10 versus 4 years, p=0.031). Multivariate regression identified tobacco exposure (OR=5.25, p=0.007, 95% CI 1.58-17.41), male sex (OR=7.48, p=0.002, 95% CI 2.15-26.01), and age (OR=1.114, p=0.002, 95% CI 1.04-1.19) as concomitant risk factors for the development of OS.

CONCLUSION

To date, there are few dedicated investigations of risk factors for OS, especially smoking. This investigation identified male sex, age, and tobacco exposure as independent risk factors for OS. Though disease duration did not withstand regression analysis in this moderately sized group, age at chart review suggests screening for OS should not remit but rather intensify in aging patients with sarcoidosis.

The prevalence of and risk factors associated with pterygium in a rural adult Chinese population: the Handan Eye Study

PURPOSE

To describe the prevalence and risk factors for pterygium in a rural adult Chinese population.

METHODS

A total of 7557 people aged 30 years and over were randomly selected from 13 villages in a rural county, Yongnian, within Handan district, Hebei Province of China. All eligible subjects were invited to undergo a comprehensive eye examination. A slit-lamp was used to examine the anterior segment for evidence of pterygium. Pterygium was graded for severity (G1 to G3) by visibility of episcleral vessels.

RESULTS

Of 6685 participants (88.5% of 7557) included in this study, pterygium was present in 401 (6.0%). Using direct standardization to the 2000 China population census for rural residents, the prevalence of pterygium was 7.1% (95% confidence interval [CI], 6.5-7.8%) among subjects aged 40+ years, and 4.8% (95% CI 4.3-5.3%) when including those aged 30-39 years. Pterygium was more common in men than in women (age-adjusted odds ratio [OR] 2.0, 95% CI 1.4-2.8). Prevalence increased with age (OR 1.8, 95% CI 1.6-2.1 per decade increase in age). Current smoking appeared to be protective (OR 0.5, 95% CI 0.4-0.7). Of eyes with any pterygium, 4.6% (95% CI 1.9-7.3%) had low vision.

CONCLUSION

Approximately one in ten adults had pterygium in this rural Chinese population. Age and male sex were positively, and current smoking negatively associated with the prevalence of pterygium.

Combined pulmonary fibrosis and emphysema in connective tissue disease

PURPOSE OF REVIEW

This review discusses combined pulmonary fibrosis and emphysema (CPFE) in the setting of connective tissue disease.

RECENT FINDINGS

CPFE is a recently identified syndrome in smokers or ex-smokers characterized by dyspnea often severe, preserved lung volumes, severely impaired gas exchanges, and an increased risk of pulmonary hypertension associated with a dismal prognosis, and possibly lung cancer. It may be encountered in the setting of connective tissue diseases, especially rheumatoid arthritis and systemic sclerosis, with generally similar features as 'idiopathic' (tobacco-related) CPFE. The diagnosis is based on the presence of both emphysema predominating in the upper lobes and frequently paraseptal, and interstitial abnormalities suggesting pulmonary fibrosis in the lower lung zones with velcro crackles at auscultation. Pathologic radiological correlations are difficult owing to various pathology and difficulties in identifying honeycombing at chest high-resolution computed tomography in the setting of coexistent emphysema. Tobacco smoking is associated with an increased risk of developing most of the individual components of the syndrome (i.e. emphysema, pulmonary fibrosis, pulmonary hypertension, rheumatoid arthritis, and pulmonary fibrosis among patients with rheumatoid arthritis). CPFE impacts modalities of follow-up for pulmonary function and detection of pulmonary hypertension especially in systemic sclerosis.

SUMMARY

The syndrome of CPFE is a distinct pulmonary manifestation in the spectrum of lung diseases associated with connective tissue diseases, especially in smokers or ex-smokers.

Effect of smoking and gender on pulmonary function and clinical features in sarcoidosis

BACKGROUND

The effect of cigarette smoking on the clinical manifestations and progression of sarcoidosis is not well characterized. We sought to determine the effects of smoking in sarcoidosis patients and to evaluate for gender-specific differences.

METHODS

We examined the effects of cigarette smoking in 518 patients seen at the Sarcoidosis and Interstitial Lung Disease Center at Wayne State University using radiographic pattern, pulmonary function testing, and clinical features of the disease. We performed a separate analysis to evaluate for gender-specific differences based on smoking history.

RESULTS

We found that smokers had significantly lower FEV(1) and FEV(1)/FVC values. Total lung capacity was not significantly different between smokers and nonsmokers, but diffusion capacity for carbon monoxide (DL(CO)) was significantly reduced in smokers. Gender-based statistical analysis showed a marked decrease in DL(CO) values among female smokers. Smokers were also found to have a higher incidence of extrapulmonary involvement as multivariate regression analysis demonstrated that both smoking and female gender are significantly associated with the development of extrapulmonary manifestations.

CONCLUSIONS

Our data indicate that both cigarette smoking and gender are important in shaping the clinical manifestations of sarcoidosis. The nature of the gender difference requires further study and may be related to differences in inflammatory response.

Sarcoidosis

Sarcoidosis is a multisystem, granulomatous disease. In this article, the various clinical manifestations, approach to, and management of, pulmonary and extrapulmonary sarcoidosis are reviewed.