Pub Date : 2026-04-01Epub Date: 2025-12-24DOI: 10.1016/j.opresp.2025.100534
Carlos Andrés Jimenez-Ruiz , José Ignacio de Granda-Orive , Carlos Rábade Castedo , Harold J. Farber , Angélica Ocampo , Susana Luhning , Beatriz Raboso-Moreno , Lola del Puerto-Garcia , Daniel Buljubasich , Manuel Conrado Pacheco-Gallego , José Antonio Castillo-Vizueta , Rosa Mirambeaux-Villalona , Marcos García-Rueda , Juan Antonio Riesco-Miranda , Ángela Ramos-Pinedo , Jaime Signes-Costa , Ledys Blanquicett-Barrios , Eva de Higes-Martinez , Catalina Casillas-Suarez , Concepción Rodríguez-García , Maribel Cristóbal-Fernández
The sale, distribution, and indiscriminate use of new tobacco and nicotine products have multiplied. The most relevant products are: electronic cigarettes (ECs), heated tobacco (HT), and nicotine pouches (NPs). From the tobacco industry and its related health sectors, and even from some health institutions with no clear influence from this industry, the use of all these devices is being promoted as an excellent harm reduction strategy for those conventional tobacco smokers who do not want to or cannot quit smoking. This paper reviewed the lack of scientific evidence of this strategy.
{"title":"Use of New Tobacco and Nicotine Products as a Harm Reduction Strategy: A Critical Review of the Evidence","authors":"Carlos Andrés Jimenez-Ruiz , José Ignacio de Granda-Orive , Carlos Rábade Castedo , Harold J. Farber , Angélica Ocampo , Susana Luhning , Beatriz Raboso-Moreno , Lola del Puerto-Garcia , Daniel Buljubasich , Manuel Conrado Pacheco-Gallego , José Antonio Castillo-Vizueta , Rosa Mirambeaux-Villalona , Marcos García-Rueda , Juan Antonio Riesco-Miranda , Ángela Ramos-Pinedo , Jaime Signes-Costa , Ledys Blanquicett-Barrios , Eva de Higes-Martinez , Catalina Casillas-Suarez , Concepción Rodríguez-García , Maribel Cristóbal-Fernández","doi":"10.1016/j.opresp.2025.100534","DOIUrl":"10.1016/j.opresp.2025.100534","url":null,"abstract":"<div><div>The sale, distribution, and indiscriminate use of new tobacco and nicotine products have multiplied. The most relevant products are: electronic cigarettes (ECs), heated tobacco (HT), and nicotine pouches (NPs). From the tobacco industry and its related health sectors, and even from some health institutions with no clear influence from this industry, the use of all these devices is being promoted as an excellent harm reduction strategy for those conventional tobacco smokers who do not want to or cannot quit smoking. This paper reviewed the lack of scientific evidence of this strategy.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100534"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100578
María Florencia Pilia , Enriqueta Felip , David Espejo , Nuria Pardo , Marta Andreu Casas , David Clofent , Ana Villar , Iñigo Ojanguren
Immune checkpoint inhibitors associated interstitial lung diseases (ICI-ILD) affect approximately 2–5% of patients receiving immunotherapy and represent one of the most serious and potentially life-threatening immune-related adverse events. The pathogenesis remains incompletely elucidated; however, current understanding suggests a multifactorial etiology involving immune dysregulation, genetic susceptibility, and pre-existing pulmonary vulnerability. ICI-ILD can occur at any time during immunotherapy, with a median onset typically occurring two to three months after the initiation of treatment. Nevertheless, cases have been reported as early as a few days and as late as one year after starting therapy. Clinical manifestations can vary considerably, ranging from asymptomatic radiographic abnormalities to severe respiratory distress. The findings of computed tomography are highly variable, and may include ground-glass opacities, consolidation, reticulation, centrilobular nodules, septal thickening, honeycombing, and traction bronchiectasis. Flexible bronchoscopy is an invasive procedure used to assess airway patency, identify endobronchial lesions, aspirate secretions, and perform bronchoalveolar lavage and transbronchial biopsy. Performing bronchoalveolar lavage is recommended to rule out infection, particularly in immunosuppressed patients, as well as to identify signs of alveolar hemorrhage. Management of ICI-ILD primarily involves systemic corticosteroids, with dosage and duration determined by the severity of the disease. Steroid-refractory immune checkpoint inhibitor pneumonitis is defined as the absence of clinical improvement after 48–72 h of high-dose corticosteroid therapy. In such cases, immunosuppressive agents such as infliximab, mycophenolate mofetil, cyclophosphamide, tocilizumab, intravenous immunoglobulin, or plasmapheresis are recommended. Rechallenge with immune checkpoint inhibitors must be individualized, considering the high risk of recurrence, particularly following severe pneumonitis.
{"title":"Immune Checkpoint Inhibitors and Interstitial Lung Disease: A Comprehensive Review of Pathogenesis, Diagnosis, and Management","authors":"María Florencia Pilia , Enriqueta Felip , David Espejo , Nuria Pardo , Marta Andreu Casas , David Clofent , Ana Villar , Iñigo Ojanguren","doi":"10.1016/j.opresp.2026.100578","DOIUrl":"10.1016/j.opresp.2026.100578","url":null,"abstract":"<div><div>Immune checkpoint inhibitors associated interstitial lung diseases (ICI-ILD) affect approximately 2–5% of patients receiving immunotherapy and represent one of the most serious and potentially life-threatening immune-related adverse events. The pathogenesis remains incompletely elucidated; however, current understanding suggests a multifactorial etiology involving immune dysregulation, genetic susceptibility, and pre-existing pulmonary vulnerability. ICI-ILD can occur at any time during immunotherapy, with a median onset typically occurring two to three months after the initiation of treatment. Nevertheless, cases have been reported as early as a few days and as late as one year after starting therapy. Clinical manifestations can vary considerably, ranging from asymptomatic radiographic abnormalities to severe respiratory distress. The findings of computed tomography are highly variable, and may include ground-glass opacities, consolidation, reticulation, centrilobular nodules, septal thickening, honeycombing, and traction bronchiectasis. Flexible bronchoscopy is an invasive procedure used to assess airway patency, identify endobronchial lesions, aspirate secretions, and perform bronchoalveolar lavage and transbronchial biopsy. Performing bronchoalveolar lavage is recommended to rule out infection, particularly in immunosuppressed patients, as well as to identify signs of alveolar hemorrhage. Management of ICI-ILD primarily involves systemic corticosteroids, with dosage and duration determined by the severity of the disease. Steroid-refractory immune checkpoint inhibitor pneumonitis is defined as the absence of clinical improvement after 48–72<!--> <!-->h of high-dose corticosteroid therapy. In such cases, immunosuppressive agents such as infliximab, mycophenolate mofetil, cyclophosphamide, tocilizumab, intravenous immunoglobulin, or plasmapheresis are recommended. Rechallenge with immune checkpoint inhibitors must be individualized, considering the high risk of recurrence, particularly following severe pneumonitis.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100578"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100583
Javier Álvarez Albarrán , Claudia Poo Fernández , Sara Naranjo Gozalo
Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies that can lead to severe complications when ruptured. We report the case of a 65-year-old active smoker who presented to the emergency department with acute pleuritic chest pain, severe dyspnea, and hypoxemia. Chest CT revealed a large PAVM in the right middle lobe, associated with massive hemothorax and a small pneumothorax. The patient had no history of hereditary hemorrhagic telangiectasia. Initial management included pleural drainage and endovascular embolization with a 16 mm Amplatzer™ device. Due to persistent respiratory failure and high risk of rebleeding, a right middle lobectomy was subsequently performed. Intraoperative findings confirmed a partially thrombosed AVM and correct device placement. Postoperative recovery was uneventful, with no recurrent bleeding. This case highlights a rare cause of spontaneous massive hemothorax requiring combined endovascular and surgical management, emphasizing the importance of early diagnosis and multidisciplinary care in idiopathic PAVMs.
{"title":"An Uncommon Cause of Massive Hemothorax: Pulmonary Arteriovenous Malformation in the Right Middle Lobe","authors":"Javier Álvarez Albarrán , Claudia Poo Fernández , Sara Naranjo Gozalo","doi":"10.1016/j.opresp.2026.100583","DOIUrl":"10.1016/j.opresp.2026.100583","url":null,"abstract":"<div><div>Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies that can lead to severe complications when ruptured. We report the case of a 65-year-old active smoker who presented to the emergency department with acute pleuritic chest pain, severe dyspnea, and hypoxemia. Chest CT revealed a large PAVM in the right middle lobe, associated with massive hemothorax and a small pneumothorax. The patient had no history of hereditary hemorrhagic telangiectasia. Initial management included pleural drainage and endovascular embolization with a 16<!--> <!-->mm Amplatzer™ device. Due to persistent respiratory failure and high risk of rebleeding, a right middle lobectomy was subsequently performed. Intraoperative findings confirmed a partially thrombosed AVM and correct device placement. Postoperative recovery was uneventful, with no recurrent bleeding. This case highlights a rare cause of spontaneous massive hemothorax requiring combined endovascular and surgical management, emphasizing the importance of early diagnosis and multidisciplinary care in idiopathic PAVMs.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100583"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100579
Cristina Matesanz-López, María Asunción Nieto-Barbero
{"title":"Nintedanib in a Dialysis Patient with Idiopathic Pulmonary Fibrosis: A One-Year Follow-Up Without Major Adverse Events","authors":"Cristina Matesanz-López, María Asunción Nieto-Barbero","doi":"10.1016/j.opresp.2026.100579","DOIUrl":"10.1016/j.opresp.2026.100579","url":null,"abstract":"","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100579"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-24DOI: 10.1016/j.opresp.2025.100535
Raúl Majo García , Cristina Díez Flecha , Sheila María Martínez Tahoces
{"title":"Do Observational Studies Overestimate the Effectiveness of Cytisinicline?","authors":"Raúl Majo García , Cristina Díez Flecha , Sheila María Martínez Tahoces","doi":"10.1016/j.opresp.2025.100535","DOIUrl":"10.1016/j.opresp.2025.100535","url":null,"abstract":"","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100535"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100580
Claudia Mañana Valdés , Miguel Arias Guillén , Germán Moris de la Tassa
Oculopharyngeal muscular dystrophy (OPMD) is a rare neuromuscular disorder that may present with respiratory complications, yet it is seldom considered in this context.
We report a 68-year-old institutionalized man, independent in daily activities, who presented with exertional dyspnea, fever, productive cough, hypoxemia, and bibasilar crackles. Laboratory tests showed normocytic anemia, lymphopenia, and elevated C-reactive protein; chest imaging revealed an alveolo-interstitial pattern. Despite empirical antibiotics, he experienced recurrent relapses with fever and radiological worsening. Immunological studies showed T-cell lymphopenia, reduced NK cells, and isolated anti-SSA/Ro52 positivity. Pneumocystis jirovecii was detected in an initial bronchoalveolar lavage but not confirmed, and no significant immunosuppression was found. Later, bilateral ptosis, proximal weakness, and oropharyngeal dysphagia prompted neuromuscular evaluation. Muscle MRI showed symmetric atrophy, and quadriceps biopsy revealed rimmed vacuoles. Genetic analysis confirmed OPMD (GCN repeat expansion in PABPN1). This case emphasizes the need to consider neuromuscular causes of recurrent pneumonia and the value of multidisciplinary, genetic-based diagnosis.
{"title":"Recurrent Pneumonia in a Patient With Oculopharyngeal Muscular Dystrophy (OPMD) due to GCN Expansion in the PABPN1 Gene: A Diagnostic Challenge","authors":"Claudia Mañana Valdés , Miguel Arias Guillén , Germán Moris de la Tassa","doi":"10.1016/j.opresp.2026.100580","DOIUrl":"10.1016/j.opresp.2026.100580","url":null,"abstract":"<div><div>Oculopharyngeal muscular dystrophy (OPMD) is a rare neuromuscular disorder that may present with respiratory complications, yet it is seldom considered in this context.</div><div>We report a 68-year-old institutionalized man, independent in daily activities, who presented with exertional dyspnea, fever, productive cough, hypoxemia, and bibasilar crackles. Laboratory tests showed normocytic anemia, lymphopenia, and elevated C-reactive protein; chest imaging revealed an alveolo-interstitial pattern. Despite empirical antibiotics, he experienced recurrent relapses with fever and radiological worsening. Immunological studies showed T-cell lymphopenia, reduced NK cells, and isolated anti-SSA/Ro52 positivity. <em>Pneumocystis jirovecii</em> was detected in an initial bronchoalveolar lavage but not confirmed, and no significant immunosuppression was found. Later, bilateral ptosis, proximal weakness, and oropharyngeal dysphagia prompted neuromuscular evaluation. Muscle MRI showed symmetric atrophy, and quadriceps biopsy revealed rimmed vacuoles. Genetic analysis confirmed OPMD (GCN repeat expansion in PABPN1). This case emphasizes the need to consider neuromuscular causes of recurrent pneumonia and the value of multidisciplinary, genetic-based diagnosis.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100580"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100582
Lucía Gimeno , Juan Rodríguez-López , Concepción Rodríguez-García , Lorena González-Justo , Manuel Ángel Martínez-Muñiz , Jesús Allende-González
To assess the real-life efficacy and safety of varenicline in a hospital-based smoking cessation program.
We conducted a longitudinal prospective study including 310 smokers treated with varenicline at our hospital's Smoking Cessation Unit between 2011 and 2021.
Abstinence rates at 3, 6, and 12 months were 51.3%, 40.0%, and 36.5%, respectively. Smoking the first cigarette within 5 min of waking was independently associated with treatment failure (OR: 2.516, p = 0.02). Adverse events occurred in 27% of patients, leading to treatment discontinuation in 11%.
Varenicline demonstrated favorable efficacy and safety in real-world clinical practice, regardless of baseline motivation or comorbidities. Active follow-up is essential to optimize adherence and long-term success.
评估伐尼克兰在医院戒烟项目中的实际疗效和安全性。我们进行了一项纵向前瞻性研究，包括2011年至2021年间在我院戒烟部门接受varenicline治疗的310名吸烟者。3、6、12个月的戒断率分别为51.3%、40.0%、36.5%。醒来后5分钟内吸第一支烟与治疗失败独立相关（OR: 2.516, p = 0.02）。27%的患者发生不良事件，11%的患者停止治疗。在现实世界的临床实践中，无论基线动机或合并症如何，伐尼克兰都显示出良好的疗效和安全性。积极的随访对于优化依从性和长期成功至关重要。
{"title":"Ten-Year Real-Life Experience With Varenicline in a Hospital-Based Smoking Cessation Program","authors":"Lucía Gimeno , Juan Rodríguez-López , Concepción Rodríguez-García , Lorena González-Justo , Manuel Ángel Martínez-Muñiz , Jesús Allende-González","doi":"10.1016/j.opresp.2026.100582","DOIUrl":"10.1016/j.opresp.2026.100582","url":null,"abstract":"<div><div>To assess the real-life efficacy and safety of varenicline in a hospital-based smoking cessation program.</div><div>We conducted a longitudinal prospective study including 310 smokers treated with varenicline at our hospital's Smoking Cessation Unit between 2011 and 2021.</div><div>Abstinence rates at 3, 6, and 12 months were 51.3%, 40.0%, and 36.5%, respectively. Smoking the first cigarette within 5<!--> <!-->min of waking was independently associated with treatment failure (OR: 2.516, <em>p</em> <!-->=<!--> <!-->0.02). Adverse events occurred in 27% of patients, leading to treatment discontinuation in 11%.</div><div>Varenicline demonstrated favorable efficacy and safety in real-world clinical practice, regardless of baseline motivation or comorbidities. Active follow-up is essential to optimize adherence and long-term success.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100582"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100581
Pablo David Fernández-Carrillo , María Fernanda García-Román , Rubén Arlegui-Tricio , Rocío Saiz-Villena , Miguel Santibáñez , David Peña-Otero
Introduction
Electronic cigarettes (ECs) or vapes, have attracted interest among both young people and adults for recreational and social reasons. The aim of this study is to determine the prevalence of EC use by gender and age in Cantabria (northern Spain), as well as the composition of the refills.
Material and methods
Cross-sectional study based on an anonymous, self-administered online questionnaire conducted from February to May 2025 (3 months). A total of 981 surveys were collected from individuals aged 15 to 64 years (inclusive).
Results
The overall prevalence of recent use (in the last 30 days) was 4.2%, while lifetime use of EC was 16.2%. By age group, usage was highest among those under 35 years old (27.1% in the 15–24 age group and 24.4% in the 25–34 age group), and below 11% in older age groups. Regarding refill composition, nicotine-containing products were the most commonly used (44.7%), followed by nicotine-free and cannabis-free refills (30.2%). Notably, 23.3% of vape users reported not knowing the composition of the refills. Only 1.9% reported using cannabis-containing refills.
Conclusions
Methodological limitations aside regarding the representativeness of our sample in relation to the entire community, these findings are consistent with national data from the latest Survey on Alcohol and Drugs in Spain (EDADES 2024), highlighting the need to design targeted intervention strategies for the young population.
{"title":"Prevalencia del uso de cigarrillos electrónicos y composición de las recargas en población juvenil y adulta de Cantabria","authors":"Pablo David Fernández-Carrillo , María Fernanda García-Román , Rubén Arlegui-Tricio , Rocío Saiz-Villena , Miguel Santibáñez , David Peña-Otero","doi":"10.1016/j.opresp.2026.100581","DOIUrl":"10.1016/j.opresp.2026.100581","url":null,"abstract":"<div><h3>Introduction</h3><div>Electronic cigarettes (ECs) or vapes, have attracted interest among both young people and adults for recreational and social reasons. The aim of this study is to determine the prevalence of EC use by gender and age in Cantabria (northern Spain), as well as the composition of the refills.</div></div><div><h3>Material and methods</h3><div>Cross-sectional study based on an anonymous, self-administered online questionnaire conducted from February to May 2025 (3 months). A total of 981 surveys were collected from individuals aged 15 to 64 years (inclusive).</div></div><div><h3>Results</h3><div>The overall prevalence of recent use (in the last 30 days) was 4.2%, while lifetime use of EC was 16.2%. By age group, usage was highest among those under 35 years old (27.1% in the 15–24 age group and 24.4% in the 25–34 age group), and below 11% in older age groups. Regarding refill composition, nicotine-containing products were the most commonly used (44.7%), followed by nicotine-free and <em>cannabis</em>-free refills (30.2%). Notably, 23.3% of vape users reported not knowing the composition of the refills. Only 1.9% reported using <em>cannabis</em>-containing refills.</div></div><div><h3>Conclusions</h3><div>Methodological limitations aside regarding the representativeness of our sample in relation to the entire community, these findings are consistent with national data from the latest Survey on Alcohol and Drugs in Spain (EDADES 2024), highlighting the need to design targeted intervention strategies for the young population.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100581"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-15DOI: 10.1016/j.opresp.2026.100577
Vicente Plaza , Gregorio Soto Campos , Juan Carlos Miralles López , Alicia Padilla Galo , Eva Martínez Moragón , Fernando Rodríguez , Mar Mosteiro , Pilar Ausín , Pilar Cebollero , Santiago Quirce , Carlos Almonacid , on behalf of the Working Group on adjusting maintenance medication in severe asthma with biologics
Introduction
Severe asthma (SA) management requires a comprehensive, individualized approach with continuous pharmacological treatment adjustments. In SA patients controlled with biologics, decisions on how to adjust maintenance therapy remain a clinical challenge, as current guidelines provide only general recommendations but lack specific practical guidance on how to implement step-down strategies.
Material and methods
A literature review about maintenance therapy step-down in SA patients was conducted, complemented by five regional expert meetings across Spain. A total of 87 allergists and pulmonologists from referral hospitals discussed four clinical questions: whether step-down is a potential therapeutic goal, the minimum clinical conditions required to initiate tapering, the duration of disease control needed, and the preferred sequence of therapy reduction. Quantitative insights were captured through televoting, complemented by structured discussions.
Results
Experts agreed that maintenance therapy step-down can be considered a potential therapeutic objective in patients with SA who achieve sustained control with biologics. Key conditions identified to start it included absence of exacerbations, nonuse of oral corticosteroids, adequate symptom control and preserved lung function for at least 6 or 12 months. A stepwise sequence for stepping-down maintenance therapy was established, prioritizing withdrawal of leukotriene receptor antagonists and high-to-low-dose reduction of inhaled corticosteroids, and finally withdrawal of long-acting beta-agonists, while maintaining low-dose inhaled corticosteroids.
Conclusions
Expert perspectives, together with clinical trial and real-world evidence, support a gradual, individualized approach guided by objective markers and close monitoring. The algorithm proposed will provide clinicians with a structured, evidence-informed framework to guide the safe and effective reduction of SA maintenance therapy in real-world practice.
{"title":"Expert Opinion and Evidence-Based Review on Maintenance Therapy Step-Down in Patients With Severe Asthma Controlled With Biologics","authors":"Vicente Plaza , Gregorio Soto Campos , Juan Carlos Miralles López , Alicia Padilla Galo , Eva Martínez Moragón , Fernando Rodríguez , Mar Mosteiro , Pilar Ausín , Pilar Cebollero , Santiago Quirce , Carlos Almonacid , on behalf of the Working Group on adjusting maintenance medication in severe asthma with biologics","doi":"10.1016/j.opresp.2026.100577","DOIUrl":"10.1016/j.opresp.2026.100577","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe asthma (SA) management requires a comprehensive, individualized approach with continuous pharmacological treatment adjustments. In SA patients controlled with biologics, decisions on how to adjust maintenance therapy remain a clinical challenge, as current guidelines provide only general recommendations but lack specific practical guidance on how to implement step-down strategies.</div></div><div><h3>Material and methods</h3><div>A literature review about maintenance therapy step-down in SA patients was conducted, complemented by five regional expert meetings across Spain. A total of 87 allergists and pulmonologists from referral hospitals discussed four clinical questions: whether step-down is a potential therapeutic goal, the minimum clinical conditions required to initiate tapering, the duration of disease control needed, and the preferred sequence of therapy reduction. Quantitative insights were captured through televoting, complemented by structured discussions.</div></div><div><h3>Results</h3><div>Experts agreed that maintenance therapy step-down can be considered a potential therapeutic objective in patients with SA who achieve sustained control with biologics. Key conditions identified to start it included absence of exacerbations, nonuse of oral corticosteroids, adequate symptom control and preserved lung function for at least 6 or 12 months. A stepwise sequence for stepping-down maintenance therapy was established, prioritizing withdrawal of leukotriene receptor antagonists and high-to-low-dose reduction of inhaled corticosteroids, and finally withdrawal of long-acting beta-agonists, while maintaining low-dose inhaled corticosteroids.</div></div><div><h3>Conclusions</h3><div>Expert perspectives, together with clinical trial and real-world evidence, support a gradual, individualized approach guided by objective markers and close monitoring. The algorithm proposed will provide clinicians with a structured, evidence-informed framework to guide the safe and effective reduction of SA maintenance therapy in real-world practice.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100577"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-24DOI: 10.1016/j.opresp.2025.100536
Ana Fernandes , Nuno Santos , Miguel Castro
{"title":"Hemoptysis in a Young Man With Behçet's Disease","authors":"Ana Fernandes , Nuno Santos , Miguel Castro","doi":"10.1016/j.opresp.2025.100536","DOIUrl":"10.1016/j.opresp.2025.100536","url":null,"abstract":"","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"8 2","pages":"Article 100536"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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