Purpose: The 6-min walk test (6MWT) is a useful tool to assess the physiologic function in patients with chronic obstructive pulmonary disease (COPD). The recent study showed that patients with COPD with oxygen desaturation during the 6MWT had an increased risk of exacerbation and death compared with those without oxygen desaturation. This study aimed to explore the potential risk factors for exercise-induced desaturation (EID) in patients with COPD. Patients and Methods: Adult patients with COPD were enrolled from the Chang Gung Research Database between January 2013 and January 2017. Age, sex, body mass index, underlying diseases, medications, and results of the pulmonary function tests and 6MWT were retrospectively collected and analyzed. Results: Among 1768 patients with COPD, 932 (52.7%) had oxygen desaturation, and the other 836 (47.3%) had no desaturation during the 6MWT. The patients with EID had a shorter 6-min walk distance than those without desaturation (352.08± 120.29 vs 426.56± 112.56, p< 0.0001). In the multivariate logistic regression analysis, older age, female sex, lower forced expiratory volume in 1 s, and comorbidity with atrial fibrillation (AF) were associated with oxygen desaturation during the 6MWT. Patients with EID had higher exacerbation frequency than those without desaturation in the 1-year follow-up period (0.59± 1.50 vs 0.34± 1.26, p< 0.0001). Patients with COPD with AF also had a higher rate of exacerbation requiring emergency department visit or hospitalization in the 1-year follow-up. Conclusion: This study demonstrates that older age, low FEV1, and female sex are risk factors for EID. Desaturation during 6MWT is related to frequent acute exacerbation of COPD in the 1-year follow-up.

Real-world clinical experience of using anti-programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs) combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer (SCLC) patients has rarely been reported. In this study, we aimed to perform a retrospective multicenter clinical analysis of extensive-stage SCLC patients receiving first-line therapy with anti-PD-L1 ICIs combined with chemotherapy. Between November 2018 and March 2022, 72 extensive-stage SCLC patients receiving first-line atezolizumab or durvalumab in combination with chemotherapy, according to the cancer center databases of Linkou, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals, were retrospectively included in the analysis. Twenty-one patients (29.2%) received atezolizumab and fifty-one (70.8%) received durvalumab. Objective response (OR) and disease control (DC) rates of 59.7% and 73.6%, respectively, were observed with first-line ICI plus chemotherapy. The median progression-free survival (PFS) was 6.63 months (95% confidence interval (CI), 5.25–8.02), and the median overall survival (OS) was 16.07 months (95% CI, 15.12–17.0) in all study patients. A high neutrophil-to-lymphocyte ratio (NLR; >4) and a high serum lactate dehydrogenase (LDH) concentration (>260 UL) were identified as independent unfavorable factors associated with shorter OS in the multivariate analysis. Regarding safety, neutropenia was the most common grade 3 treatment-related adverse event (AE), but no treatment-related deaths occurred in the study patients. First-line anti-PD-L1 ICIs combined with chemotherapy are effective and safe for male extensive-stage SCLC patients. Further therapeutic strategies may need to be developed for patients with unfavorable outcomes (e.g., baseline high NLR and serum LDH level).

Late-onset asthma (LOA) differs from early-onset asthma (EOA) in terms of prognosis and the treatment response because it has a much worse prognosis and a poorer response to standard asthma treatment. This study sought to investigate the characteristics and clinical outcomes of asthma patients with phenotypes distinguished by age at onset and atopy status. We prospectively recruited patients with asthma who were registered in a pay-for-performance program operated by Taiwan’s National Health Insurance Administration (NHIA). These patients received regular outpatient treatment for at least 1 year at every outpatient clinic visit since 2019. Baseline characteristics and clinical outcomes were compared between patients with LOA (≥40 years) and those with EOA (<40 years). Of the consecutive 101 patients with asthma, 21 patients (20.7%) had EOA and 80 (79.3%) had LOA. In the 12-month period, patients with EOA had higher declines in forced expiratory volume in one second (FEV₁; −2.1 ± 8.4 vs. 6.8 ± 13.1, % of predicted value, p = 0.037) and forced vital capacity (FVC; −4.6 ± 12.0 vs. 6.1 ± 13.6, % of predicted value, p = 0.023) than patients with LOA. Patients with nonatopic EOA had a significantly higher exacerbation rate at 12 months than patients with nonatopic LOA (50% vs. 11.8%, p = 0.012). Identification of different phenotypes of asthma is important in clinical practice because treatment responses may differ.

The 6 minute walk test (6MWT) is a tool to assess the physiologic function in variable pulmonary diseases. Oxygen desaturation during 6MWT is a risk factor for exacerbations and mortality in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). We investigate whether exercise desaturation pattern during 6MWT is different between ILD and COPD. 53 COPD patients and 51 ILD patients performed 6MWT. Pulmonary function test took before and after 6MWT. The relationship of tidal loop and forced expiratory flow-volume (FEFV) curve, and continuous heart rate and saturation every minute (min) during 6MWT and 1 min after stopping walk were analyzed. Desaturation was defined as a 4% decrease of oxygenation compared to the baseline saturation. There were more encroachments of tidal loop with FEFV curve in both pre-exercise (69.8% vs 15.7%) and post-exercise (62.3% vs 19.6%) in COPD group than in ILD group (p<0.001). A left shift of tidal loop after 6MWT was significantly increased in COPD than in ILD (43.4% vs 7.8%, p<0.001). The heart rate was significantly increased in early 1 min though 4 min and after rest at 1 min in ILD patients than COPD patients. The desaturation happened early at 1 min to 6 min in 6MWT and 1 min stopping walk in ILD patients. However, the desaturation was found later at 4 minute of 6MWT in COPD patients. 6MWT revealed that ventilation/perfusion mismatch may induce early desaturation in ILD, while dynamic hyperinflation leading to late desaturation in COPD. Different patterns of the relationship of heart rate and saturation in 6MWT may be helpful for distinguishing chronic lung diseases.

Background: In non-cystic fibrosis bronchiectasis, small airway airflow limitation is primarily driven by mucus plugging, chronic neutrophilic inflammation, and epithelial injury. These primary mechanisms lead to subsequent airway remodelling and luminal narrowing. Such functional impairment is clinically significant, as a reduced distance–saturation product (DSP) of <280 m% during the 6-minute walk test (6MWT) is associated with increased mortality. Objective: To evaluate the association between small airway dysfunction (SAD), exercise-induced desaturation (EID), and impaired exercise capacity in patients with bronchiectasis. Design: A retrospective, cross-sectional study. Methods: This retrospective study included 114 patients with bronchiectasis (non-desaturators, n = 57; desaturators, n = 57) and 53 non-bronchiectasis controls. Impulse oscillometry (IOS), spirometry, and 6MWT data were analysed. Desaturators were defined as a maximal decline in peripheral oxygen saturation (ΔSpO ₂ ) ≤ −4% during the 6MWT. Results: Compared with bronchiectasis non-desaturators (n = 57), desaturators (n = 57) exhibited more pronounced IOS-defined SAD, characterised by higher R ₅ –R ₂₀ , F _res , and A _X , and lower X ₅ , as well as spirometry-defined SAD with lower MMEF%pred and FEF50%pred. Desaturators also demonstrated a shorter 6-minute walk distance (6MWD). Greater R ₅ –R ₂₀ , F _res , and A _X , and lower X ₅ , MMEF%pred, and FEF50%pred were associated with a larger reduction in ΔSpO ₂ , shorter 6MWD, and lower DSP. The multiple linear regression showed age, BRICS, and R ₅ -R ₂₀ are independent predictors for DSP. Among them, R ₅ -R ₂₀ (β=-0.345) is a stronger predictor than BRICS (β=-0.285) for DSP. Conclusion: SAD is independently associated with EID and reduced exercise capacity in bronchiectasis, highlighting its potential role as a functional marker beyond structural disease severity.