Current Opinion in Pulmonary Medicine最新文献

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.

Purpose of review: Hospitalists are at the forefront of managing chronic obstructive pulmonary disease (COPD) exacerbations. While patients may be followed by a pulmonologist outpatient, their care in the hospital is largely managed by internists. Our review addresses critical aspects of COPD care for the patient admitted to the hospital under the care of internal medicine.

Recent findings: When patients are hospitalized for COPD, the hospitalist has a critical opportunity to address tobacco cessation, vaccinations, and end-of-life issues. For hospitalists who are in academic medicine, teaching trainees the important mimickers of COPD exacerbations and how to establish the diagnosis are critical for their training. While these patients are hospitalized, ensuring adequate sleep and avoiding unnecessary night-time nebulizer use allows for patient recovery and wellbeing.

Summary: COPD exacerbations represent an opportunity for hospitalists to provide high-quality, comprehensive care for the patient and invaluable teaching for the trainee.

Purpose of review: The use of electronic cigarettes (e-cigarettes) for delivering nicotine has increased markedly in recent years, raising concerns regarding their long-term safety and their potential to sustain nicotine dependence, particularly among adolescents and young adults. Marketed as safer alternatives to conventional cigarettes, e-cigarettes warrant careful evaluation of both their short-term and long-term health risks.

Recent findings: Evidence from systematic reviews suggests that e-cigarettes may serve as a tool for smoking reduction or cessation; however, available data indicate that usage often represents product switching rather than complete cessation. Given that e-cigarettes are not harmless, the advisability of recommending them as a smoking cessation aid remains controversial. Although long-term outcomes are not fully established, current research suggests that e-cigarettes could be responsible for acute lung injury, exacerbations of respiratory symptoms, chronic obstructive pulmonary disease progression, and various pathophysiological changes associated with cytotoxicity and airway dysfunction.

Summary: Considering the accumulating evidence of harm, e-cigarettes should be regulated similarly to conventional tobacco products, with strict restrictions on access for children and adolescents. Further longitudinal studies are needed to clarify their long-term health effects and to guide evidence-based public health policies.

Purpose of review: The legalization of recreational and medical cannabis has shifted consumption patterns, with vaping emerging as a common alternative to smoking. This review summarizes recent evidence comparing the respiratory and cardiovascular health effects of these two modes of administration.

Recent findings: Vaping reduces exposure to combustion-related toxicants and allows modulation of Δ9-tetrahydrocannabinol (THC) bioavailability compared to smoking cannabis. However, both modes of consumption produce comparable physiological effects, including acute increases in heart rate and blood pressure, and altered immune responses in lung. There is clear association between THC vaping and e-cigarette or vaping associated lung injury. Vaping is also linked to increased risk of respiratory symptoms. Evidence regarding the long-term risks of vaping cannabis such as chronic obstructive pulmonary disease, lung cancer, myocardial infarction and stroke remains limited and inconclusive.

Summary: While vaping cannabis may mitigate some combustion-related harms compared to smoking, it introduces distinct respiratory and cardiovascular concerns. Evidence on long-term comparative safety remains limited, highlighting the need for longitudinal and experimental studies examining health outcomes across different modes of consumption, devices, temperatures and formulations.

Purpose of review: Chronic obstructive pulmonary disease (COPD) is a leading cause of worldwide morbidity and mortality, yet significant barriers in its diagnosis and management persist. Artificial intelligence is rapidly emerging as a powerful tool to address these challenges. This review summarizes recent trends in its application to advance the care of patients with COPD, focusing on imaging and physiologic parameters.

Recent findings: Recent literature demonstrates significant progress in artificial intelligence enhanced imaging, with deep learning models applied to chest radiographs and computed tomography showing high accuracy in detecting COPD, quantifying disease features, and predicting clinical outcomes including exacerbations and mortality. Machine learning algorithms are improving the interpretation of pulmonary function tests and leveraging novel data streams from cough sounds and wearable smart devices for noninvasive diagnosis, severity assessment, and the prediction of acute exacerbations.

Summary: While artificial intelligence holds immense potential to shift COPD care toward a more proactive and personalized model, most applications remain in early developmental stages, with critical challenges including the need for rigorous clinical validation, addressing algorithmic bias, and establishing standardized evaluation metrics.

Purpose of review: Artificial intelligence (AI) is in the era of rapid evolution. Like other healthcare fields, AI has significantly impacted sleep medicine. We aim to explain the evolving role of AI in sleep medicine and provide clinicians with key information related to its benefits and limitations.

Recent findings: AI technologies, like machine learning and deep learning, improve the detection of sleep disorders, such as obstructive sleep apnea, insomnia, and narcolepsy, through advanced data analysis from tools like polysomnography and consumer sleep devices. AI also enables targeted therapies by endotyping sleep disorders, optimizing patient care, and reducing unnecessary treatments. On the other hand, there are many challenges that need to be addressed before using AI in clinical settings. Ethical issues regarding patient privacy, biases, and transparency regarding data use are some of the key challenges.

Summary: AI could transform sleep medicine by enhancing diagnostic accuracy and personalizing treatment plans. Effective collaboration between clinicians and AI experts is necessary to use AI optimally in clinical settings.

Purpose of review: There is a significant overlap between the diagnostic evaluation for adult and pediatric patients with bronchiectasis; however, also important age-specific unique considerations. This review focuses on these specific considerations.

Recent findings: Bronchiectasis refers to the radiographic evidence of dilation of distal and proximal bronchi secondary to chronic infection and inflammation. Bronchiectasis can be suspected on plain chest radiograph but is confirmed and detailed through computed tomography (CT) imaging. Several different measures and descriptions of the radiographic findings of bronchiectasis exist, but the most common is a bronchial diameter equal to or greater than an adjacent blood vessel. Consideration for the presence of bronchiectasis begins with recognition of clinical symptoms of suppurative lung disease including persistent sputum producing cough and recurrent respiratory infections. Bronchiectasis etiologies include inherited forms, such as cystic fibrosis and primary ciliary dyskinesia, as well as secondary forms including chronic aspiration as well as certain infections, and immunodeficiency. Up to 40% remain idiopathic even after a comprehensive evaluation.

Summary: It is important to start a bronchiectasis evaluation with a broad differential, but secondary testing should focus on etiologies specific to the patient. A thoughtful combination of testing is often required to arrive at an etiology. Patients with bronchiectasis require ongoing monitoring including longitudinal follow-up of respiratory cultures, lung function testing, and repeat CT imaging.

Purpose of review: Idiopathic hypersomnia is a chronic and often disabling sleep disorder characterized by excessive daytime sleepiness despite adequate or prolonged nighttime sleep. With recent advances in diagnosis and treatment, this review is timely in addressing evolving approaches to understanding and managing idiopathic hypersomnia, a condition that remains underrecognized and frequently misdiagnosed.

Recent findings: Idiopathic hypersomnia is clinically distinct from narcolepsy, lacking REM-related features such as cataplexy and hypnagogic hallucinations. Until recently, treatment options for idiopathic hypersomnia were limited and often off-label. The 2021 FDA approval of low-sodium oxybate (LXB) marked the first medication specifically indicated for idiopathic hypersomnia. Additional agents such as modafinil, pitolisant, and traditional stimulants are used off-label with varying efficacy. Ongoing research is exploring promising treatments, including orexin-2 receptor agonists (e.g. ALKS 2680, ORX-750), serdexmethylphenidate, and flumazenil, which offer new hope for personalized management.

Summary: Growing insights into the pathophysiology and clinical features of idiopathic hypersomnia have led to improved diagnostic clarity and therapeutic innovation. These developments carry significant implications for clinical practice, offering hope for better symptom control and quality of life in affected individuals. Ongoing research is crucial for refining treatment strategies and deepening our understanding of this complex condition.

Purpose of review: The relationship between obstructive sleep apnea (OSA) and the gut microbiota is increasingly recognized, yet the involvement of specific microbial taxa and the direction of causality remain unclear. This review synthesizes current evidence linking gut dysbiosis with disordered sleep, with a focus on OSA and its associated complications.

Recent findings: Studies of alpha and beta microbial diversity in OSA patients, sampled at different sites, have had inconsistent results. Members of the genus Fusobacterium and family Lachnospiraceae are enriched in some studies of OSA and have been linked with gut barrier permeability and complications, such as hypertension. OSA treatments, including positive airway pressure and GLP-1 agonists, have varying effects on the microbiota.

Summary: Microbiota-targeted therapies may reduce OSA-related complications, but these potential treatments require additional well designed trials to clarify the bidirectional relationship between gut microbes and sleep-related health.

Purpose of review: The advent of CFTR modulators and the adoption of telemedicine during the COVID-19 pandemic have prompted reconsideration of cystic fibrosis (CF) care models. This review explores how care delivery may evolve in response to these changes.

Recent findings: Emerging evidence highlights the heterogeneity in response to CFTR modulators, with some patients continuing to experience disease progression. Preliminary trial data have explored therapy de-escalation, but long-term safety remains uncertain. Challenges in microbiological surveillance, particularly due to reduced sputum production, complicate monitoring. Early efforts to define "stability" have led to position statements advocating risk-stratified, hybrid care models.

Summary: CF care models should shift toward individualized, flexible approaches that prioritize equity and safety. Clinical trials and registry analyses will be essential to validate such models. Until then, conservative implementation with continued multidisciplinary support and objective monitoring are advised.