Seminars in respiratory and critical care medicine最新文献

Pulmonary rehabilitation is a comprehensive, interdisciplinary intervention that aims to enhance the physical and psychological well-being of individuals with chronic respiratory diseases. This approach entails the implementation of tailored therapies, including exercise training, education, and behavioral modification. Sleep plays a crucial role in numerous physiological processes, including the regulation of inflammation and tissue repair, both of which are fundamental to the efficacy of rehabilitation. A paucity of optimal sleep health has been associated with deleterious effects on pivotal factors that are indispensable for favorable outcomes in pulmonary rehabilitation, including mental and physical health and immune function. This, in turn, may increase susceptibility to impaired pulmonary function. The integration of pulmonary rehabilitation protocols with healthy sleep practices is expected to yield significant improvements in lung function and overall health, which will, in turn, promote long-term adherence to rehabilitative behaviors. This study aims to examine the relationship between sleep health and pulmonary rehabilitation outcomes.

Obstructive sleep apnea (OSA) is a widespread condition associated with an elevated risk of adverse outcomes. Continuous positive airway pressure (CPAP) is the gold standard treatment, particularly for moderate to severe OSA. However, in many instances, CPAP compliance falls short of expectations, necessitating physicians to consider additional interventions to alleviate patient symptoms. A comprehensive understanding of OSA endotypes and phenotypes can potentially enhance the confidence in selecting the appropriate combination or intervention to improve patient care. In this review, we will discuss various interventions and medications available to enhance the treatment of patients with OSA, following a precision medicine approach.

Whenever a new COVID-19 vaccination season starts, we must face new challenges, including which vaccines to use, the update of the high-risk groups to be vaccinated, and especially the type and amount of information to be communicated to people in order to promote vaccination. COVID-19 vaccination recommendations should fit these specific conditions. The use of effective vaccines against the predominant SARS-CoV-2 virus variants and the extent of the immune response (waning immunity) are key aspects to try to protect better the high-risk populations. Updated vaccines are currently swiftly available. However, the number of people vaccinated with any additional booster dose is declining. Improved health information and training for health care professionals, together with the use of better tools to make simpler vaccination recommendations, can encourage higher vaccination rates. Addressing these challenges is essential to improve vaccination coverage and ensure adequate protection in the face of evolving COVID-19 threats. The SARS-CoV-2 virus has become a constant presence in our society. The virus changes but is neither endemic nor seasonal so far. The Omicron variant prevailed for nearly 2 years and now several of its subvariants like JN.1, KP.2, or XEC are or can be the dominant ones. In the face of this moving situation, the main message must be the same: COVID-19 vaccines are safe and effective. The role of current COVID-19 vaccination efforts is to mitigate the severity of the disease and reduce the risk of complications and death, instead of preventing most SARS-CoV-2 infections. New vaccines against COVID-19 are now at different stages of clinical research.

Lower respiratory tract infection (LRTI) is a major cause of neonatal morbidity and mortality worldwide. Maternal vaccination is an effective strategy in protecting young infants from LRTI, particularly in the first few months after birth when infant is most vulnerable, and most primary childhood vaccinations have not been administered. Additionally, maternal vaccination protects the mother from illness during pregnancy and the postnatal period, and the developing fetus from adverse outcomes such as stillbirth and prematurity. In this paper, we review the safety, efficacy, and effectiveness of maternal vaccines against LRTIs, such as pertussis, influenza, coronavirus disease 2019, and respiratory syncytial virus.

Respiratory infections are associated with a huge burden of disease every year and disproportionately affect older adults, namely those aged 65 years and older. Older adults are at increased risk of infections compared with their younger counterparts, and once infected, have a higher risk of experiencing severe disease course, complications, and long-term sequelae. Therefore, vaccination is clearly a key strategy to prevent infection and its attendant negative consequences. We review here the burden of common respiratory diseases in older adults, namely influenza, pneumococcal disease, and respiratory syncytial virus. We then review some of the challenges facing immunization of older adults, namely immunosenescence, inflammaging, and low vaccine uptake. Next, potential opportunities for overcoming these challenges are reviewed, including the use of higher antigen doses and/or adjuvants in vaccine formulations for older adults, and the potential of multiomics analyses to improve development, performance, and implementation of vaccines.

In this review, we present the efforts made so far in developing effective solutions to prevent infections caused by seven major respiratory pathogens: influenza virus, respiratory syncytial virus (RSV), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Bordetella pertussis, Streptococcus pneumoniae (pneumococcus), Mycobacterium tuberculosis, and Pseudomonas aeruginosa. Advancements driven by the recent coronavirus disease 2019 (COVID-19) crisis have largely focused on viruses, but effective prophylactic solutions for bacterial pathogens are also needed, especially in light of the antimicrobial resistance (AMR) phenomenon. Here, we discuss various innovative key technologies that can help address this critical need, such as (a) the development of Lung-on-Chip ex vivo models to gain a better understanding of the pathogenesis process and the host-microbe interactions; (b) a more thorough investigation of the mechanisms behind mucosal immunity as the first line of defense against pathogens; (c) the identification of correlates of protection (CoPs) which, in conjunction with the Reverse Vaccinology 2.0 approach, can push a more rational and targeted design of vaccines. By focusing on these critical areas, we expect substantial progress in the development of new vaccines against respiratory bacterial pathogens, thereby enhancing global health protection in the framework of the increasingly concerning AMR emergence.

Respiratory syncytial virus (RSV) is a common respiratory virus associated with acute respiratory infections (ARIs) in infants and older adults. RSV-related ARIs significantly affect the relevant clinical outcomes, including hospitalization and mortality, in older adults. Elderly individuals and those with chronic diseases are at a higher risk of infections with severe morbidity because of clinical frailty and deficiencies in immune responses. Prevention of respiratory viral infections in the adult population can be achieved through hygiene measures and active immunization. Several vaccination strategies have been developed, including nucleic acid, subunit, chimeric, live-attenuated, particle-based, and recombinant vaccines, with varying results. Subunit vaccines involving the RSV-fusion protein F in its prefusional (pre-F) conformation, with or without adjuvants, have demonstrated significant protection in older adults, reducing the rate of total and severe RSV-related lower tract respiratory diseases (LRTDs). Similarly, an mRNA vaccine encoding for the stabilized pre-F conformation showed a significantly reduced RSV-associated LRTDs in older adults. This evidence led to recent approval of two subunit vaccines (Arexvy and Abrysvo) and one nucleic acid-based vaccine (mResvia) by regulatory authorities. Currently, several vaccines are recommended for adults, resulting in crowded schedules. Therefore, covaccination is a potential strategy for improving vaccine adherence. The coadministration of approved RSV vaccines with seasonal influenza vaccines has been proven to be non-inferior to the immune response from sequential administration. Other vaccines coadministered against different pathogens are currently under investigation.

Streptococcus pneumoniae remains one of the leading causes of mortality and morbidity in children and in the elderly worldwide. Pneumococcal conjugated vaccines (PCVs) have reduced invasive and noninvasive pneumococcal disease in children and adults. However, challenges persist due to serotype replacement, epidemiological diversity, and global inequalities in vaccine access. The future of PCVs is structured around three major areas of innovation: expanding antigenic coverage, developing serotype-independent formulations, and introducing advanced technological platforms such as the multiple antigen presenting system. The challenge is to better improve immunogenicity beyond serotypes and to extend the global impact of vaccines with more equitable and effective global rates of vaccination.

During the 2023/24 season, nirsevimab significantly reduced the risk of bronchiolitis and confirmed respiratory syncytial virus (RSV) infections in primary care, hospital, and pediatric intensive care unit admissions among infants aged 0 to 11 months, even in a season with a high community RSV burden, particularly for older infants. These findings are very useful for public health authorities to continue to implement immunization campaigns against RSV in the coming seasons. Moreover, universal immunization against RSV represents a transformative step toward reducing the burden of RSV in infants. With promising evidence from recently published studies, the expectations for a reduction of RSV-associated hospitalizations, alongside the improvement of public health outcomes and equitable access to these measures, are high. However, achieving these goals will require addressing challenges related to vaccine uptake, funding, and RSV surveillance to prompt detect resistances due to mutations of the virus. These interventions need to be integrated into public health strategies because they hold the potential to make a significant impact on infant's health worldwide.

Pertussis, a highly contagious respiratory disease, is preventable with vaccine. Two types of vaccines are used around the world: whole-cell pertussis vaccines (wP), which contain inactivated bacterial suspensions are difficult to produce and induce some side effects, and acellular pertussis vaccines (aP), which contain one to five purified bacterial antigens, chemically or genetically detoxified. Both the vaccines succeeded in massively decreasing child deaths caused by pertussis. However, irrespective of vaccination, the disease is still endemic around the world, and cycles of pertussis are still observed every 3 to 5 years in both wP- or aP-vaccinated regions. The interval between each cycle, and the intensity and incidence of the disease during these cycles vary. The first challenge ahead is to rapidly increase vaccine coverage by vaccinating infants on time, introducing regular vaccine boosters throughout life, and vaccinating pregnant women. The second challenge is to introduce an effective disease surveillance such as a pediatric hospital surveillance, allowing an estimation of the incidence of severe disease in the pediatric population, and/or a sentinel surveillance, allowing to detect changes in the incidence of the disease in the population. All surveillance systems require a functional network of physicians in the country aware of the clinical forms of the disease in children, adolescents, adults, and seniors. Surveillance is required to adapt vaccine strategies according to the vaccine type and to follow the evolution of the agents of the disease. The third challenge is to pursue research to improve these vaccines. However, before changing vaccines once again, an evaluation of the exact consequences of aP or wP vaccines under specific vaccine strategies needs to be carefully carried out.