Current Opinion in Pulmonary Medicine最新文献

Purpose of review: Indoor water parks, with over 1100 facilities in the United States, are popular recreational venues with an estimated 1.5 million visitors per year in North America. While generally well tolerated, they can be associated with significant respiratory and nonrespiratory health risks. This review focuses exclusively on the infectious and noninfectious respiratory health issues associated with indoor water park usage and is timely due to increasing popularity, evolving water-treatment practices, and the unique vulnerability of specific populations.

Recent findings: This review synthesizes peer-reviewed studies and institutional data from 2014 to 2024, detailing exposure mechanisms, health effects, mitigation strategies, and impacts on vulnerable populations such as children, asthmatic individuals, cystic fibrosis patients, immunocompromised individuals, and workers. Topics covered include disinfection by-products (DBPs), chloramine inhalation effects, asthma risks, hypersensitivity pneumonitis from nontuberculous mycobacteria, and occupational exposures. Emerging technologies in air and water quality management, alongside recent policy and facility-design developments, are also examined.

Summary: While indoor water parks remain a valued recreational resource, they pose significant and often under-recognized respiratory risks. Through better facility ventilation, hygiene education, disinfection innovation, and regulatory reform, these risks can be mitigated to protect both patrons and staff, particularly in vulnerable subpopulations.

Purpose of review: Linear endobronchial ultrasound (EBUS) plays a central role in the diagnosis and mediastinal staging of lung cancer. Recent advancements, including the 9th edition of the International Association for the Study of Lung Cancer (IASLC) TNM staging system and updated guidelines for neoadjuvant therapy, have significantly influenced its clinical utility. This review highlights these key developments and examines the expanding role of EBUS-guided tissue acquisition techniques and rapid on-site evaluation (ROSE).

Recent findings: The IASLC 9th edition offers a more nuanced nodal classification, reinforcing the importance of accurate EBUS-guided lymph node assessment. As neoadjuvant therapies become more common, precise pretreatment staging is critical for treatment planning. Emerging biopsy techniques, such as EBUS-guided intranodal forceps biopsy and cryobiopsy, yield larger tissue samples, improving diagnostic accuracy in complex cases, including lymphoma and benign diseases. Additionally, the integration of artificial intelligence into ROSE enhances the real-time diagnostic performance and mitigates the limitations of traditional cytopathology.

Summary: EBUS has evolved from diagnostic modality to a cornerstone of personalized lung cancer management. A clear understanding of updated staging systems, therapeutic guidelines, and biopsy strategies is essential. Future research should aim to establish evidence-based diagnostic algorithms incorporating these innovations to optimize patient care.

Purpose of review: Peripheral lung lesions remain a prevalent and diagnostically challenging clinical entity. While computed tomography (CT)-guided transthoracic needle aspiration has been the gold-standard for tissue diagnosis, recent advances in technology have led to an increase in the ability of navigational bronchoscopy to successfully reach these lesions.However, despite successful bronchoscopic navigation based on preprocedural CT, diagnostic yield remains low if the proceduralist is unable to identify and correct CT-to-body divergence or confirm tool-in-lesion while sampling the lesion.The use of improved intraprocedural imaging techniques and biopsy tools have provided new techniques to correct positioning and sample lesions with greater diagnostic yield.

Recent findings: Integration of axial imaging in the form of fixed and mobile cone beam CT, digital tomosynthesis, and augmented fluoroscopy into bronchoscopic procedures have led to improved diagnostic accuracy. These advances improve peripheral bronchoscopy through identification and compensation of navigational errors relative to changes in real-time lesion location and confirmation of biopsy instrument location within the lesion.

Summary: Real-time imaging that is capable of identifying and correcting for CT-to-body divergence is vital to the increased diagnostic accuracy of peripheral bronchoscopic procedures.

Purpose of review: Airway foreign body aspiration remains a potentially life-threatening emergency, predominantly affecting children under 5 years and adults over 65 years. This review synthesizes current evidence on diagnostic strategies, bronchoscopic extraction techniques, procedural outcomes, complication management, and emerging technologies in airway foreign body management.

Recent findings: Multidetector computed tomography with three-dimensional reconstruction has significantly improved diagnostic accuracy, achieving sensitivity of 98-99% for radiopaque objects and 85-92% for radiolucent materials. Flexible bronchoscopy has evolved from a diagnostic tool to a first-line therapeutic modality, with recent pediatric meta-analyses demonstrating 87% success rates and adult series showing comparable outcomes to rigid bronchoscopy for appropriately selected cases. Rigid bronchoscopy maintains superiority in asphyxiating presentations, and for large (>1.5 cm), sharp, or severely impacted foreign bodies. Technological innovations including robotic-assisted bronchoscopy, electromagnetic navigation systems, and artificial intelligence-powered imaging analysis are enhancing procedural precision and safety.

Summary: Successful airway foreign body management requires individualized, multidisciplinary approaches integrating patient clinical status, foreign body characteristics, and institutional expertise. Success depends on appropriate bronchoscopic modality selection, comprehensive preprocedural planning, availability of specialized retrieval instruments, and readiness to manage potential complications. Integration of advanced imaging, simulation-based training protocols, and telemedicine consultation are becoming essential components of contemporary practice.

Purpose of review: Advances in diagnostic bronchoscopy seek to optimize diagnostic yield while maintaining the safety profile of conventional bronchoscopy. Despite rapid technological progress, inconsistent outcome definitions have hindered pooling of data across studies and comparisons across technologies. This review aims to clarify how a standardized definition of diagnostic yield can enhance comparability and clinical interpretation in advanced diagnostic bronchoscopy.

Recent findings: The recent ATS/CHEST consensus statement provides a rigorous framework for defining and reporting diagnostic yield, enabling meaningful cross-study comparisons. Beyond definitions of diagnostic outcome measures, optimization of tissue acquisition and processing through close collaboration between bronchoscopists and pathologists is critical. Current evidence supports the use of coordinated sampling strategies to secure sufficient, high-quality material for molecular testing, particularly for large-panel next-generation sequencing (NGS). Advances in EBUS-TBNA, cryobiopsy, and robotic bronchoscopy have improved sample yield and quality for genomic profiling. In parallel, liquid biopsy using circulating tumor DNA provides a minimally invasive adjunct, particularly valuable when tissue is limited, exhausted, or longitudinal monitoring is required; however, its sensitivity remains constrained in low-shedding diseases.

Summary: Adherence to a strict definition of diagnostic yield, combined with optimized sampling and integrated molecular testing, ensures that technological innovation in bronchoscopy translates into clinically meaningful, precise, and patient-centered diagnosis of lung cancer.

Purpose of review: Peripheral bronchoscopy is increasingly practiced to gain access to peripheral pulmonary lesions (PPLs). Lung cancer screening with low-dose computed tomography (CT) is fuelling the need for superior navigational tools such as robot-assisted bronchoscopy to target screen-detected pulmonary nodules which may be as small as 6 mm.

Recent findings: It is an opportune moment to return to the basics of performing peripheral bronchoscopy through revising airway mapping with CT imaging. Virtual bronchoscopy, electromagnetic navigation bronchoscopy (ENB) and robot-assisted bronchoscopy (RAB) have yet to supplant the accuracy of manual airway mapping achieved simply by CT reading. The technique of airway mapping should be consistently utilised for airway navigation as it is complementary to technologies such as virtual bronchoscopy, ENB or RAB. In this review, we share the technique of performing airway mapping with a case illustration, and our approach to peripheral bronchoscopy.

Summary: Airway mapping is a foundational skill that must be preserved, practiced and perfected in our bronchoscopic approach to a PPL. In the absence of advanced navigational tools, peripheral bronchoscopy can be performed in combination with readily available tools to obtain a high diagnostic yield.

Purpose of review: Aerodigestive fistulas (ADFs) cause significant morbidity and mortality, especially in advanced malignancies. This review summarizes current knowledge on etiology, diagnostic, and management strategies.

Recent findings: Esophageal carcinoma is the predominant cause of malignant ADFs with their development influenced by tumor location, most often involving the upper and middle thirds of the esophagus, and by prior interventions such as radiotherapy or esophageal stenting.Benign acquired ADFs typically result from iatrogenic injuries including pressure necrosis from cuffed tubes, stent erosion, endoscopy, and surgery. Diagnosis often is delayed by nonspecific symptoms, requiring combined imaging and endoscopic evaluation. Benign ADFs are typically amenable to surgical repair, whereas malignant fistulas usually require individualized palliation, notably airway and esophageal stenting. Dual airway-esophageal stenting has advantages over single stenting for malignant ADFs due to superior quality of life and survival outcomes. Emerging minimally invasive techniques include endoscopic clips, occluder devices, and tissue adhesives.

Summary: Optimal management of ADFs requires high clinical vigilance, timely diagnostic evaluation, and individualized multidisciplinary approaches. Further research into emerging therapies and standardized management algorithms is essential for improving patient outcomes and guiding evidence-based clinical practice.

Purpose of review: This review traces the historical evolution of bronchoscopy, from its origins in the late nineteenth century to its current role as a central tool in interventional pulmonology. It highlights major technological and clinical milestones and considers how early innovations continue to shape modern practices. As bronchoscopy enters the era of robotics and artificial intelligence, this reflection offers a timely perspective on its future trajectory.

Recent findings: Advances in both rigid and flexible bronchoscopy have enhanced visualization, navigation, and therapeutic precision. Interventions such as airway stenting, cryotherapy, endobronchial valve placement, and nonthermal ablation are now routine. These developments build on historical foundations and support a more targeted, minimally invasive approach to pulmonary intervention.

Summary: The evolution of bronchoscopy reflects a legacy of innovation driven by clinical need and technological advancement. Rigid and flexible techniques remain vital, while recent advances in robotics, artificial intelligence navigation, and image-guided interventions signal a new era. A deep appreciation of its historical development informs current practice and shapes the integration of emerging technologies into the future of interventional pulmonology.

Purpose of review: Peripheral bronchoscopy has become a widely adopted, minimally invasive modality for the diagnosis of peripheral lung lesions. However, its diagnostic yield remains limited in part due to intra-procedural atelectasis - a frequently overlooked phenomenon that obscures lesions and exacerbates computed tomography (CT)-to-body divergence. This review highlights the prevalence and clinical impact of atelectasis during navigational bronchoscopy and presents anesthesia and ventilation strategies to mitigate its occurrence.

Recent findings: Emerging data from trials such as I-LOCATE, ventilatory strategy to prevent atelectasis (VESPA), and lung navigation ventilation protocol (LNVP) studies show that atelectasis develops early and frequently during bronchoscopy, particularly in dependent lung zones and patients with high BMI. Strategies to reduce atelectasis include high tidal volumes, optimized positive end-expiratory pressure, reduced FiO 2 , and recruitment maneuvers. Dedicated ventilation protocols like VESPA and LNVP have significantly reduced both incidence and severity of atelectasis, improved lesion visibility, and demonstrated safety. Apneic breath-hold techniques further enhance image quality and lesion targeting.

Summary: Atelectasis is a modifiable barrier to diagnostic success in peripheral bronchoscopy. Proactive pre and intra-procedural planning, implementation of structured ventilation protocols, and close collaboration with anesthesia are essential. Future research should focus on protocol standardization, novel imaging synchronization techniques, and validation of atelectasis grading tools.

Purpose of review: Robotic Assisted bronchoscopy has emerged as an important tool in diagnosing small peripheral lung nodules in the era of CT screening. This paper reviews results from recent publications.

Recent findings: Three meta -analyses have now been reported. Diagnostic yields reported in studies must be considered in terms of the study prevalence of malignancy, which if high tends to give higher overall diagnostic yield. Diagnostic yields are consistently an improvement on earlier technologies, particularly for lesions <20 mm in size. A range of imaging modalities have emerged as significant ways to improve diagnostic yield in Robotic procedures. These may be "stand alone" or integrated into the robotic systems. Robotic procedures may be performed under a single anaesthetic with planned surgical excision, the latter being guided by rapid on-site assessment or frozen section. Learning curve appears to be short and high levels of diagnostic performance with good safety profile have been reported.

Summary: Ongoing clinical study with robotic nodule biopsy will continue given the significant advance it has provided to clinicians in the first 5 years of its introduction.