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Journal articleKc S, Hopkinson NS, Neves AL, et al., 2026,
Impact of Patient Portals on Asthma and Chronic Obstructive Pulmonary Disease-Related Quality-of-Care Outcomes: Systematic Review.
, Online J Public Health Inform, Vol: 18, ISSN: 1947-2579BACKGROUND: Patient portals are increasingly used to support self-management and facilitate care coordination in people with chronic diseases. Although some asthma quality-of-care gains and modest chronic obstructive pulmonary disease (COPD) improvements have been reported in wider digital health studies, a comprehensive review of patient portal-specific evidence is lacking. OBJECTIVE: This study aimed to systematically synthesize evidence on the impacts of patient portals on adult asthma and COPD outcomes across 6 quality-of-care domains (effectiveness, patient-centeredness, equity, efficiency, safety, and timeliness). METHODS: We searched 5 databases (MEDLINE/PubMed, Embase, PsycINFO, CINAHL, and Google Scholar) for quantitative evaluations published up to March 2026 (CRD42022316044). The Newcastle-Ottawa Scale and Cochrane Risk of Bias-2 tool were used for quality assessments, and certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Findings were narratively synthesized using the SWiM (Synthesis Without Meta-analysis) framework. RESULTS: We identified 4038 records, and 16 papers published between 2007 and 2024 met the inclusion criteria (asthma=13, COPD=2, both=1). Three were randomized controlled trials, all rated high risk of bias. Of the other studies, 5 had low risk, 6 had moderate risk, and 2 had high risk of bias. Effectiveness and patient-centeredness were most frequently reported, with 12 papers each. Eight papers were on equity, 5 each on efficiency and safety, and 4 on timeliness. In asthma, modest disease control improvements were reported in 27.8% (42/151) of participants using patient portals with home visit support versus portal use alone (35/150, 23.3%). In COPD, one large, interrupted time series study (N=909,724) reported post-implementation reductions in hospitalizations (slope change from 1.33 to -4.38 per 10,000 patients per month; P<.001) but no mortality benefit
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Journal articleWang R, Chen Y, Liu X, et al., 2026,
Extracellular vesicles in senescence-associated chronic lung diseases.
, Chin Med J (Engl), Vol: 139, Pages: 2392-2408Chronic lung diseases, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, obstructive sleep apnea, asthma, bronchiectasis, and lung cancer, are intricately linked to the aging process. These diseases are characterized by a high prevalence rate and a paucity of effective treatment options. Emerging evidence highlights the critical role of extracellular vesicles (EVs) in the pathogenesis and progression of these diseases. EVs, released by senescent cells, mediate intercellular communication and modulate immune responses through their cargo of microRNAs, proteins, and other molecules. These vesicles contribute to disease progression by promoting inflammation, fibrosis, tissue remodeling, and cellular senescence. Specifically, certain microRNAs, such as miR-21, miR-34a, and miR-570-3p, along with several proteins in EVs, have been identified as key factors influencing these processes. Additionally, EVs play significant roles in immune regulation and have potential anti-inflammatory effects, making them promising candidates for therapeutic applications. Recent advances in the use of EVs as therapeutic agents, including their application in nanotechnology for targeted drug delivery, have demonstrated potential in reducing inflammation, modulating immune responses, and enhancing tissue repair. Understanding the role of EVs in these diseases offers insights into potential therapeutic targets to mitigate disease progression and improve patient outcomes. Future research should focus on standardizing EV isolation and characterization methods, verifying the safety and efficacy of EV-based therapies in clinical trials, and elucidating the complex biological mechanisms of EVs in aging and disease.
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Journal articleHillson K, Oritz KM, Hay S, et al., 2026,
High oral corticosteroid use during acute attacks of preschool wheeze irrespective of clinical phenotype
, Archives of Disease in Childhood, ISSN: 0003-9888Objective This study aims to evaluate the burden of oral corticosteroid (OCS) use and any relationship to clinical phenotype in preschool children presenting with acute wheeze attacks.Methods Single-centre prospective study in which children with recurrent, severe preschool wheeze (PSW), who were referred to a tertiary respiratory centre, had symptom questionnaire, point-of-care blood eosinophil count (BEC) and aeroallergen sensitisation tests undertaken on the same day as their outpatient clinic appointment.Results 100 children with PSW (median age 3.5 years; IQR 2.8–4.9 years; 51% male) were recruited. Clinical atopy, based on parental reporting, was present in 42%, while objective sensitisation, confirmed by testing, was observed in 35%. Median lifetime OCS courses per child was 10 (IQR 6–18) and 5 (IQR 3–7) during the preceding 12 months. Regardless of which definition of atopy was used, atopic children had higher BEC when well, compared with non-atopic children: using clinical atopy classification, median BEC was 0.65 versus 0.3×10⁹/L (p=0.003) and using objective atopy, median BEC was 0.7 versus 0.3×10⁹/L (p<0.0001). There was no difference in the use of OCS in the acute setting between higher and lower BEC, between clinical or objective atopy or a combination of these either over the child’s lifetime or during the previous 12 months.Conclusion Children with severe, recurrent PSW are being treated with large numbers of OCS courses despite the lack of evidence of significant efficacy. There is an urgent need for trials which include phenotyping of acute attacks to guide OCS treatment.
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Journal articleGerth van Wijk R, Mahler V, Albrecht M, et al., 2026,
Factors for Success and Failure of Allergen Immunotherapy (AIT) Trial Design in the Light of Evidence-Based Medicine: Current Aspects 2026.
, AllergyAllergen immunotherapy (AIT) has been acknowledged as the only disease-modifying treatment for respiratory diseases since its introduction in 1911. Although the efficacy and safety have convincingly been established in numerous randomized clinical trials (RCTs), the AIT study results may vary substantially. Several factors that may influence the outcome of RCTs will be addressed. First, the choice of the primary endpoint is essential. Lack of validated endpoints with proven clinical relevance may contribute to the variation in study results. Secondly, heterogeneity of the patient population affects the study outcome, thereby raising the question of whether current selection criteria should be further optimized to capture those patients who will benefit from immunotherapy. Thirdly, variability and particularly low allergen exposure may lead to unsuccessful AIT trials. Fourthly, unsuccessful trials may stem from large placebo effects. Furthermore, discrepancies between Phase II and III studies are asking for cautious interpretation of Phase II studies when planning Phase III studies. Flaws in trial design, inadequate reporting of the clinical trial protocol and data may hamper the interpretation of study results. In addition, this review addresses specific aspects of AIT trial design in children and asthmatic patients. To improve future AIT trials, innovative solutions are urgently needed, including the establishment of an internationally accepted minimal clinically important difference (MCID), the validation of primary endpoints, the integration of field studies and allergen exposure chamber studies, and the publication of negative study results.
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Journal articleGalant SP, Karp T, Kuks PJM, et al., 2026,
Small airway disease predicts exacerbation risk in well-controlled, but not in poorly-controlled asthma: A post hoc analysis of the ATLANTIS study.
, J Allergy Clin Immunol Pract -
Journal articleBaylis S, Hopkinson NS, Feliu A, et al., 2026,
Statement of the European Respiratory Society on the tobacco endgame
, European Respiratory Journal, Vol: 68, ISSN: 0903-1936 -
Journal articleCanizales J, Schofield S, Shamji MH, et al., 2026,
Patterns of mouse allergen–specific IgE and IgG4 in contemporary animal research environments
, Clinical and Experimental Allergy, Vol: 56, Pages: 983-985, ISSN: 0954-7894 -
Journal articleWilson-Morkeh H, Seluk L, Bosch P, et al., 2026,
Targeting Immunologic Pathways in Eosinophilic Granulomatosis With Polyangiitis: Translating Emerging Evidence Into Clinical Practice.
, Allergy, Vol: 81, Pages: 2775-2791Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare and potentially life-threatening systemic, inflammatory disease with multi-organ manifestations, variable presentation and complex pathology. Multiple interconnected immunological pathways are implicated in EGPA pathology, including a type-2 immune response driving predominantly eosinophilic inflammation, B-cell mediated autoimmunity, neutrophil activation, and the generation of pathogenic anti-neutrophil cytoplasmic antibodies, all of which can contribute to tissue/organ damage. High-dose glucocorticoids are the mainstay treatment for EGPA, but over the past two decades the development of biologic treatments targeting interleukin (IL)-5, eosinophils and B-cells has revitalized the treatment landscape. Mepolizumab, a humanized monoclonal antibody that specifically targets IL-5, and benralizumab, which targets the IL-5 receptor (IL-5Rα), are both approved for the treatment of patients with non-severe relapsing or refractory EGPA. In Phase III trials, these biologics have demonstrated favorable safety profiles and efficacy, with treatment leading to remission induction, remission maintenance, and oral glucocorticoid sparing benefits. However, as understanding of the full complexity of EGPA pathogenesis improves, new treatment targets are emerging. Consequently, understanding key pathogenic mechanisms at the patient level, enabling a more tailored treatment approach, is an important goal for future research.
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Journal articleChae W, An J, Lee W, et al., 2026,
Circulating 1-Methylnicotinamide Predicts Dupilumab Response in Adult Asthma: A Prediction Model.
, Clin Exp Allergy, Vol: 56, Pages: 935-938Plasma 1‐methylnicotinamide is elevated in dupilumab responders, outperforming conventional type‐2 biomarkers. Combining 1‐methylnicotinamide with FeNO achieves the highest predictive accuracy for dupilumab treatment response.
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Journal articlePeter J, Jindal A, Del Giacco S, et al., 2026,
Urticaria and Angioedema: When East Meets West-and the Middle.
, Allergy, Vol: 81, Pages: 2579-2581 -
Journal articleWu Z, Moor K, Wijsenbeek MS, et al., 2026,
The Impact of Disease Severity and Symptoms on Anxiety and Depression in Individuals With Idiopathic Pulmonary Fibrosis.
, Chest, Vol: 170, Pages: 467-476BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a debilitating, life-limiting fibrotic lung disease. Symptoms including breathlessness, cough, and fatigue, together with disease severity, contribute to psychological burden, yet their relationship with anxiety and depression remains unclear. RESEARCH QUESTION: In patients with IPF, what is the prevalence and severity of anxiety and depression, and what are their associations with symptoms and disease severity? STUDY DESIGN AND METHODS: This observational study prospectively recruited patients with incident IPF. Hospital Anxiety and Depression Scale (HADS), Dyspnea-12, Leicester Cough Questionnaires, cough visual analog scales, Living with IPF (L-IPF), and lung function were assessed at baseline and 12 months. RESULTS: Two hundred sixty-nine patients with IPF (mean age, 73.5 years; 81% male) were recruited; 157 completed follow-up. Mean FVC % predicted ± SD was 79% ± 14.7%. At baseline, the prevalence of anxiety and depression (HADS score ≥ 8) was 27.5% and 28.3%, respectively (suggestive HADS 8-10: 18.6% and 14.9%; probable HADS ≥ 11: 8.9% and 13.3%, respectively). On multivariable analysis, worse Dyspnea-12 and poorer L-IPF energy were independent factors for both anxiety and depression at baseline; younger age was a factor for anxiety. Baseline lung function did not correlate with HADS anxiety or HADS depression. At follow-up, HADS anxiety scores increased numerically, below reported minimal clinically important difference values, with no change in HADS depression scores. Younger age, higher Dyspnea-12 scores, and poorer L-IPF energy were associated with greater increases in anxiety. Moderate or weak correlations were observed between changes in HADS and longitudinal changes in patient-reported outcomes (worsening breathlessness, cough, and energy levels). Changes in FVC % predicted did not correlate with HADS. INTERPRETATION: Our results show that anxiety and depression are common in patient
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Journal articleKuks PJM, Aabed AMA, Premereur LCA, et al., 2026,
Clinical phenotyping of asthma patients with elevated sputum eosinophils and low blood eosinophils: a post-hoc analysis of the multicentre ATLANTIS cohort.
, EBioMedicine, Vol: 130BACKGROUND: Patients with eosinophilic asthma are responsive to treatment with corticosteroids and biologics. Eosinophilia is usually identified based on blood eosinophil counts, but there is discordance between blood and sputum in some cases. A subset of patients may have sputum eosinophilia despite low blood eosinophil levels. The clinical implications of this so-called isolated sputum eosinophilia are unknown. The aim of this study is to investigate the clinical expression of asthma in patients with isolated sputum eosinophilia. METHODS: In this post-hoc ATLANTIS analysis we included patients with available blood and/or sputum data from ATLANTIS. Patients were classified according to blood eosinophils (< or ≥300 cells/μL). Patients with isolated sputum eosinophilia were compared with those with low eosinophils in both compartments. FINDINGS: Of the 487 patients with low blood eosinophils counts, sputum samples were available in 146. Among these, 25 (17%) had isolated sputum eosinophilia. Compared with patients with low eosinophils in both compartments (n = 121), patients with isolated sputum eosinophilia had more airflow obstruction (FEV1/FVC ratios (68.8% vs. 75.4%, p <0.01)) and small airways dysfunction (Scond0.05 vs. 0.03 1/L, p = 0.02) and more frequently reported exacerbations in the year prior to inclusion (28% vs. 9%, p = 0.01). Clinical characteristics were broadly comparable to those observed in patients with blood eosinophilia. INTERPRETATION: Isolated sputum eosinophilia occurs in a subgroup of patients with asthma, in association with worse clinical outcomes. These findings suggest that airway eosinophilia may not always be captured by conventional blood biomarkers and warrant further investigation into the clinical implications of this phenotype to determine whether these patients may benefit from treatment strategies targeting type 2 inflammation, such as intensified steroids or biologics. FUNDING: Chiesi Farmaceutici sponsored the ATLA
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Journal articleKlimek L, Mullol J, Hummel T, et al., 2026,
The Unmet Need of Olfactory Testing in Inflammatory Disorders of the Upper Airways-An EAACI Position Paper.
, Allergy, Vol: 81, Pages: 2633-2655The sense of smell, with its extensive evolutionary history, is highly prone to disorders that can have a profound impact on daily life. Anosmia affects approximately 5% of the population, with an additional 15% exhibiting reduced olfactory function. The prevalence of olfactory dysfunction (OD) varies by population and age group, and standardized testing reveals a broad range of impacts. OD includes various causes, most commonly aging, inflammation of the olfactory epithelium, upper respiratory tract infections (URTI), traumatic brain injury, and neurological conditions. The recent COVID-19 pandemic has highlighted the association between viral infections and olfactory dysfunction, with severe hyposmia/anosmia being an early marker of infection. Despite its importance, the assessment of olfactory function remains inconsistent across clinical practices. Psychophysical smell tests, while vital for diagnosis and patient management, are underutilized, especially outside of specialized centers. Standardized testing methods are crucial for objective diagnosis, but significant challenges, including test variability, lack of comparability, and healthcare reimbursement issues, persist. The European Academy of Allergy and Immunology (EAACI) advocates for improvements in the quality and standardization of chemosensory assessments. Future efforts must prioritize education, incentives for better testing, and the integration of digital tools to expand access to olfactory testing and diagnosis in remote or quarantine situations. However, office-based testing remains irreplaceable, even with advancements in telemedicine.
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Journal articleMakrufardi F, Chuang H-C, Lin Y-C, et al., 2026,
Effect of ambient relative humidity and particulate matter on the levels of asthma therapy.
, World Allergy Organ J, Vol: 19, ISSN: 1939-4551OBJECTIVE: We aimed to investigate the associations of the daily mean and short-term variation in ambient relative humidity (RH), temperature, and fine particulate matter (PM2.5) with asthma treatment steps. METHODS: We consecutively recruited 288 newly diagnosed adult patients with asthma and followed them for at least 6 months according to the Global Initiative for Asthma (GINA) strategy. Odds ratios (ORs) for higher GINA treatment steps required to achieve asthma control were estimated using logistic regression. We also conducted exposure-response analyses to explore potentially nonlinear relationships between environmental exposure and asthma treatment step across seasons. RESULTS: A 1% increase in the 1-day RH difference and a 1-μg/m3 increase in the 7-day PM2.5 difference were associated with 1.054-fold and 1.052-fold higher odds of step 4 treatment, respectively. A 1% increase in the 1-day RH difference and a 1-μg/m3 increase in the 7-day PM2.5 difference were associated with 1.047-fold and 1.056-fold higher odds of medium-dose inhaled corticosteroids plus long-acting beta-agonists (ICS + LABA), respectively. A 1% increase in the 7-day RH mean and a 1-μg/m3 increase in the 30-day PM2.5 difference were associated with 1.075-fold and 1.205-fold higher odds of triple inhaler therapy and biologics use, respectively. Exposure-response analyses suggested noticeable seasonal patterns for temperature and RH in relation to asthma treatment strategy. CONCLUSIONS: Our exploratory and hypothesis-generating findings showed that greater short-term variation in RH and PM2.5 was associated with higher treatment intensity in adult asthma, particularly the use of medium-dose ICS + LABA and biologics. Higher RH mean was also associated with triple inhaler therapy. These associations were more evident during the cold season. Multicenter validation studies in larger population studies are warranted.
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Journal articleLachover-Roth I, Chan ES, Erdle SC, et al., 2026,
The effect of transient early consumption of cow's milk formula on the risk of cow's milk allergy requires studies with sufficient power.
, J Allergy Clin Immunol Pract, Vol: 14, Pages: 1934-1937 -
Journal articleBognanni A, Sousa-Pinto B, Morais-Almeida M, et al., 2026,
World Allergy Organization (WAO) Consensus on the use and practice of precautionary allergen labelling: The international ACT-UP! e-Delphi.
, World Allergy Organ J, Vol: 19, ISSN: 1939-4551BACKGROUND: The Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO) recently convened an expert consultation to address the increasing but inconsistent use of Precautionary Allergen ("may contain") Labelling (PAL). OBJECTIVES: We conducted a Delphi study to explore the perspectives of clinicians, patient representatives, and other interest-holders on PAL practice. METHODS: We followed previous guidance on Delphi study development and reporting. A narrative review exploring the FAO/WHO Expert Consultation informed the Delphi process. The working group generated 35 items based on the review of FAO/WHO consultation, categorized into 7 domains: (i) Importance of the issue, (ii) Informing use of PAL, (iii) Action level cut-offs, (iv) Communication, (v) Liability considerations, (vi) Free From statements, and (vii) Areas for further research. Items underwent 3 iterative Delphi rounds involving a panel of 35 experts who rated their agreement narratively and on a 5-point Likert scale. Consensus was defined as ≥70% consistency in agreement or disagreement (excluding neutral responses); stability was defined as <10% variation in average scores across rounds. A public consultation was held to collect different viewpoints arising from the consensus activity. RESULTS: The Delphi was concluded after 3 rounds with consensus achieved for 33/35 items. Response rate was 100% across all 3 rounds. The panel strongly agreed that PAL should only be applied when an unintended allergen may be present above a cut-off (action level) and that it should always be based on a formal risk assessment, preferably quantitative, and mandated through legislation. Furthermore, action levels should be based on "reference doses" (amount of total allergenic protein), rather than on a concentration (eg, 10 ppm), and more specifically on population-adjusted eliciting doses ED05 (amount of allergen expected to elicit an objective rea
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Journal articleBousquet J, Sousa-Pinto B, Shamji MH, et al., 2026,
ARIA-EAACI 2025: Person-Centred, Digitally Enabled and Artificial Intelligence-Assisted Change Management in Airway Diseases: An OECD Best Practice for Integrated Care for Chronic Diseases.
, Clin Transl Allergy, Vol: 16, ISSN: 2045-7022Allergic Rhinitis and its Impact on Asthma (ARIA) was, up until 2017, a guideline using the best evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) and developed as a change management strategy. A second change management strategy-in collaboration with the European Academy of Allergy and Clinical Immunology (ARIA-EAACI)-was developed as a person-centred, digitally enabled, artificial intelligence-assisted care (person-centred care) with strong political involvement. The digital tools of ARIA are mainly based on MASK-air, an Organisation for Economic Co-operation and Development (OECD) Best Practice for integrated care for chronic diseases. Artificial intelligence was used, in particular, to approach the patients' views and expectations. The current paper describes the steps to build and achieve a new change management strategy. The future of the Change Management strategy is (i) a collaboration between ARIA and EAACI, (ii) the development of ARIA 2024-2025 guidelines, (iii) the new ARIA-MeDALL classification of multimorbid airway diseases and (iv) embedding MASK-air in a registry for severe allergic diseases. The ultimate goals of the ARIA-EAACI change management strategy will be (i) the transformation of health and care in rhinitis and asthma multimorbidity and (ii) the development of novel guidelines and policies in a cost-effective manner, improving shared-decision-making.
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Journal articleLogan J, Martin K, Gillespie L, et al., 2026,
Asthma exacerbation profile of benralizumab for severe eosinophilic asthma (the BenRex study): a multicentre, prospective cohort study.
, Lancet Respir Med, Vol: 14, Pages: 683-693BACKGROUND: Benralizumab, an interleukin-5 receptor α antagonist, depletes blood eosinophils, reducing exacerbations of severe asthma by approximately 50% versus placebo. In this study, we aimed to characterise mechanisms underlying exacerbations occurring on benralizumab. METHODS: BenRex, a multicentre, prospective cohort study, recruited participants meeting national licensing criteria for benralizumab for asthma. The study was conducted in 15 UK severe asthma centres. After collecting baseline data, open-label benralizumab was administered for 12-18 months. At exacerbation, participants attended for medical review before initiating treatment, fractional exhaled nitric oxide (FeNO), spirometry, asthma control questionnaire, and blood and sputum sampling. FINDINGS: Between Sept 30, 2019, and April 23, 2024, 121 exacerbation events were assessed in 156 individuals. 90 participants (58%) were female and 66 (42%) were male; 147 (94%) of participants identified as White. Median blood eosinophil counts at exacerbation were 0 (IQR 0-0) cells per μL. Airway neutrophilia was present in 55% of exacerbations where sputum was available (27/49). Median C-reactive protein (CRP) increased from 3·00 mg/L (1·00-6·00) at baseline to 9·00 mg/L (3·00-17·00) at exacerbation (p=0·0067). Clinically relevant viral pathogens were seen in eight (20·5%) of 39 sputum samples; although viruses were detected in 22 (56·4%) of 39 samples. Influenza A, metapneumovirus, and rhinovirus were the most common viral pathogens (each found in 2 [5·1%] of 39 samples). New acquisition of Moraxella catarrhalis (3 [13·6%] of 22), Haemophilus influenzae (4 [18·2%] of 22), and Streptococcus pneumoniae (2 [9·1%] of 22) occurred. DNA-neutrophil elastase complexes (p=0·0080) and azurocidin-1 (p=0·012) concentrations rose from baseline to exacerbation. FeNO was ≥50 parts per billion in 56 (50·
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Journal articleMolyneaux PL, Hirani NA, Chia CCK, et al., 2026,
Inhaled LTI-03 for idiopathic pulmonary fibrosis: a randomized dose escalation study.
, Nat Commun, Vol: 17Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease with limited treatment options. LTI-03 promotes alveolar epithelial cell survival and reduces profibrotic protein expression in experimental models of IPF. In this Phase 1b, randomized, double-blind, placebo-controlled dose-escalation study, 24 participants with IPF were randomized 3:1 to inhaled LTI-03 5 mg/day (N = 9), LTI-03 10 mg/day (N = 9) or placebo (N = 6) for 14 days and included in all analyses (ClinicalTrials.gov: NCT05954988). The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs). Exploratory analyses included pharmacokinetics and disease-related biomarkers. LTI-03 was well-tolerated, with no treatment-related discontinuations, no severe TEAEs, and no evidence of airway obstruction by spirometry and associated symptoms. In deep bronchial brushings, both LTI-03 doses significantly reduced interleukin-11 (p = 0.0406 at 5 mg/day; p = 0.044 at 10 mg/day) and thymic stromal lymphopoietin (p = 0.0256 at 5 mg/day; p = 0.0128 at 10 mg/day) versus placebo. The 10 mg/day dose suppressed collagen type 1 alpha chain 1 (p = 0.0248), CXC chemokine ligand 7 (p = 0.0248) and galectin-7 (p = 0.0332). Other measured biomarkers were not significantly changed. The favorable safety profile and reductions in disease-related biomarkers support further evaluation of inhaled LTI-03 for IPF. This study was fully funded by Rein Therapeutics, Inc.
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Journal articleAlqarni F, Kumasaka S, Taylor M, et al., 2026,
Abnormalities of the distal terminal ileum in people with cystic fibrosis assessed using magnetic resonance imaging.
, J Cyst FibrosBACKGROUND: The terminal ileum (TI) is commonly affected in people with cystic fibrosis (pwCF), but limited quantitative information is available on its appearance and dimensions. This study aimed to use magnetic resonance imaging (MRI) to: 1) measure the diameter of the distal TI in healthy volunteers (HVs) and pwCF; 2) test the hypothesis that the diameter of the TI in pwCF is larger than in HVs. METHODS: Twenty-six adult pwCF (23 on modulators) and 30 HVs participated. A commercial image analysis platform (Entrolytics, Motilent, UK) was used to measure the long and short axes diameters of the TI on cross-sectional images, along the most distal 5 cm before the ileo-caecal valve. The cross-sectional area of the TI was calculated assuming an elliptical shape. RESULTS: (mean±SD) pwCF had a larger TI compared with HVs: the long axis TI diameter (1.6 ± 0.3 cm for HVs versus 2.7 ± 0.7 cm for pwCF, p < 0.0001), the short axis TI diameter (1.2 ± 0.3 cm versus 2.2 ± 0.6 cm respectively, p < 0.0001) and the TI cross-sectional area (1.6 ± 0.7cm2 versus 4.9 ± 2.5cm2 respectively, p < 0.0001). Sixty-five% of pwCF showed heterogeneous, faeces-like chyme presence in the TI. CONCLUSIONS: This study showed that the TI is enlarged and filled with heterogeneous, faeces-like chyme in pwCF compared with HVs. These findings are in keeping with earlier surgical reports. Increased chyme viscosity and/or impaired motility may lead to accumulation of chyme in the TI in pwCF. New treatments correcting these abnormalities such as secretagogues could be evaluated using the new MRI-derived TI diameter and area endpoints.
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