European Respiratory Review最新文献

Background: Health disparities are prevalent across respiratory diseases. Social determinants of health are closely associated with health disparities and account for between 30% and 55% of all health outcomes. In people with interstitial lung disease (ILD), disparities have the potential to significantly impact access to care and health outcomes along many stages of the disease journey.

Aim: This review aimed to provide an overview of health disparities in ILD, focusing on the determinants of health and access to care from diagnosis to end of life and to report on some approaches being proposed to address these disparities.

Methods: A narrative review of the literature was undertaken using three electronic databases (Ovid Embase, Medline and CINAHL) from inception to May 2024. Disparities and social determinants were mapped to the domains of the Dahlgren-Whitehead model of social determinants of health.

Results: A total of 31 studies were eligible for inclusion. Common disparities identified included differences in antifibrotic utilisation, representation in clinical trials, access to ILD care and lung transplantation waiting lists. Associated social determinants included race/ethnicity, gender, geography and socioeconomic status. Paradoxically, telehealth technology and utilisation have the potential to improve access to diagnostic and treatment options for marginalised communities but may exacerbate disparities for those with lower digital literacy and access.

Conclusion: Reducing health disparities in ILD will require an awareness and understanding of the root cause of the disparities at both the individual and societal level in order to develop effective interventions that improve access to care for all living with ILD.

Background: Pleural diseases represent a significant healthcare burden, affecting over 350 000 patients annually in the US alone and requiring accurate diagnostic approaches for optimal management. Traditional imaging techniques have limitations in differentiating various pleural disorders and invasive procedures are usually required for definitive diagnosis.

Methods: We conducted a nonsystematic, narrative literature review aimed at describing the latest advances in imaging techniques and artificial intelligence (AI) applications in pleural diseases.

Results: Novel ultrasound-based techniques, such as elastography and contrast-enhanced ultrasound, are described for their promising diagnostic accuracy in differentiating malignant from benign pleural lesions. Quantitative imaging techniques utilising pixel-density measurements to noninvasively distinguish exudative from transudative effusions are highlighted. AI algorithms, which have shown remarkable performance in pleural abnormality detection, malignant effusion characterisation and automated pleural fluid volume quantification, are also described. Finally, the role of deep-learning models in early complication detection and automated analysis of follow-up imaging studies is examined.

Conclusions: Advanced imaging techniques and AI applications show promise in the management and follow-up of pleural diseases, improving diagnostic accuracy and reducing the need for invasive procedures. However, larger prospective studies are needed for validation. The integration of AI-driven imaging analysis with molecular and genomic data offers potential for personalised therapeutic strategies, although challenges in data privacy, algorithm transparency and clinical validation persist. This comprehensive approach may revolutionise pleural disease management, enhancing patient outcomes through more accurate, noninvasive diagnostic strategies.

The ideal definition of asthma remission should be practical, measurable and meaningful for both patients and physicians, while also representing true disease modification. Unfortunately, current proposals to define asthma remission fall short of this standard, not for lack of careful consideration, but due to the challenges presented by asthma, including but not limited to variability in symptom perception, intrinsic variability in lung function, seasonality and the impact of comorbidities. This article discusses obstacles and challenges to developing a widely adopted, consensus definition of asthma remission. We searched the literature for keywords including "asthma", "remission" and "super-responder" and identified interventional trials in asthma that highlight the challenges inherent in defining asthma remission.

Background: Although there is agreement on surgically removing symptomatic congenital lung malformations (CLMs), the management of asymptomatic cases remains controversial. Some paediatric surgeons suggest conservative management for asymptomatic cases due to the low perceived risk of developing symptoms or malignancy. This study aimed to investigate the characteristics and management of adults with CLMs.

Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted to find studies reporting on adult patients (aged ≥15 years) with CLMs.

Results: Out of 12 908 studies reviewed from 1947 to 2024, 653 studies met the inclusion criteria, covering 980 patients. None of the patients had a prenatal diagnosis. The mean±sd age at surgery was 39.4±15.7 years (range 15-86). A total of 74.4% of adults with CLMs presented with symptoms, leading to the detection of CLM. Pneumonia was the most common symptom in congenital pulmonary airway malformation (CPAM) and intralobar sequestration, with over 30% of these patients experiencing recurrent respiratory infections. In 11.7% of adults, CLMs harboured tumours at the time of surgical removal, with CPAM associated with lung tumours in over 20% of cases.

Conclusions: Thoracic surgeons recommend surgical resection for all adult CLM patients, including asymptomatic cases, due to risks of infections and malignancy. Conservative management was considered only when surgery was not feasible.

Background: Lung volume reduction, either surgical or bronchoscopic, is an effective therapeutic strategy that improves pulmonary function, quality of life and exercise capacity in patients with advanced emphysema. The aim of this review was to evaluate the extrapulmonary effects of this treatment.

Methods: PubMed, Embase and Web of Science were searched until 19 August 2024. The extrapulmonary effects were classified into nine distinct domains. Studies that reported outcomes related to one of the predefined extrapulmonary domains with a follow-up duration of at least 1 month were eligible for inclusion. A descriptive summary of the effects from all studies was compiled.

Results: A total of 85 articles were included. The majority of studies were conducted in patients who underwent lung volume reduction surgery (74%). The greatest improvements were found in respiratory muscle strength, ventilatory drive, diaphragm morphology and body mass index. While the effects were less pronounced, beneficial outcomes were also observed for body composition, inflammation, oxidative stress, anxiety, depression and bone mineral density. The overall treatment effect of lung volume reduction on cardiac function and pulmonary arterial pressure was inconclusive; however, there is no evidence to suggest any significant deterioration. For the extrapulmonary domains of cognition, sleep and peripheral muscle function, evidence is currently insufficient to determine whether lung volume reduction has any impact.

Conclusion: Lung volume reduction treatment has multiple beneficial extrapulmonary effects in patients with severe emphysema and lung hyperinflation. These findings support the use of lung volume reduction as a treatment for this patient population.

Asthma treatment has seen significant advancements over the recent years. However, despite improvements in disease control, some patients continue to experience persistent symptoms and exacerbations, necessitating a deeper understanding of disease mechanisms and optimisation of treatment strategies. The introduction of biologics has marked a new era in severe asthma management, targeting underlying molecular mechanisms and raising the possibility of achieving asthma remission. Key indicators of remission include high asthma control, absence of exacerbations and stabilised, or normalised, lung function. However, there is currently no common definition for remission, with various studies using different criteria. Real-world studies and post hoc analyses of clinical trials emphasise the potential of biologics in achieving clinical remission in a significant proportion of patients. Here, we provide a comprehensive review of studies in support of incorporating asthma remission as potential goal in asthma management. Despite the lack of a universally accepted definition and large prospective studies focused on remission, we believe that incorporating long-term outcomes and the currently accepted elements of remission in the approach to asthma care will shift the emphasis from reactive symptom control to proactive disease management, ultimately aiming for better asthma outcomes.

Noncystic fibrosis bronchiectasis, hereafter referred to as bronchiectasis, is a chronic, progressive lung disease that can affect people of all ages. Patients with clinically significant bronchiectasis have chronic cough and sputum production, as well as recurrent respiratory infections, fatigue and impaired health-related quality of life. The pathophysiology of bronchiectasis has been described as a vicious vortex of chronic inflammation, recurring airway infection, impaired mucociliary clearance and progressive lung damage that promotes the development and progression of the disease. This review describes the pivotal role of neutrophil-driven inflammation in the pathogenesis and progression of bronchiectasis. Delayed neutrophil apoptosis and increased necrosis enhance dysregulated inflammation in bronchiectasis and failure to resolve this contributes to chronic, sustained inflammation. The excessive release of neutrophil serine proteases, such as neutrophil elastase, cathepsin G and proteinase 3, promotes a protease-antiprotease imbalance that correlates with increased inflammation in bronchiectasis and contributes to disease progression. While there are currently no licensed therapies to treat bronchiectasis, this review will explore the evolving evidence for neutrophilic inflammation as a novel treatment target with meaningful clinical benefits.