Breathe最新文献

Tuberculosis (TB) remains the leading cause of death from a single infectious agent, with 10.8 million cases reported in 2023. While treatment is generally effective, both drug-susceptible (DS-TB) and drug-resistant TB (DR-TB) regimens are associated with adverse events (AEs) that compromise adherence and outcomes. In this viewpoint, we highlight the most clinically relevant AEs: hepatotoxicity, cutaneous reactions and ocular toxicity in DS-TB; and linezolid-associated neuropathy, myelosuppression, QT prolongation and hepatotoxicity in DR-TB. We argue that structured safety monitoring and integration of active TB Drug Safety Monitoring and Management into routine care are critical to improving patient safety. Looking ahead, pharmacogenomics, therapeutic drug monitoring, predictive algorithms and digital health solutions offer opportunities to move from reactive to proactive AE management. By prioritising monitoring, innovation and patient-centred approaches, TB programmes can reduce the burden of AEs, improve adherence and achieve better outcomes.

Tuberculosis (TB) continues to be a global clinical and public health threat, particularly in low- and middle-income countries. TB care has primarily been centred around timely diagnosis and expanding access to treatment. Post-TB lung disease (PTLD), characterised by persistent respiratory symptoms, functional impairment and structural lung changes, is highly prevalent among TB survivors, with a prevalence ranging from 40% to 90%. This requires an effort to evaluate TB survivors in need of further care at the end of anti-TB treatment, for consideration of pulmonary rehabilitation. This review provides an overview of the current evidence and best practices in pulmonary rehabilitation for PTLD. This article aims to bridge the gap between evidence and practice, supporting tailored, multidisciplinary approaches to pulmonary rehabilitation, building on the existing experiences and challenges from diverse settings. Furthermore, this review supports the ongoing educational efforts of healthcare professionals to reframe TB care, placing long-term health and patient wellbeing at the centre of post-TB management.

An introduction to two issues of Breathe that focus on pulmonary infections https://bit.ly/4aFmbGI.

Macrolides are known to play a key role in the treatment of nontuberculous mycobacteria. However, the optimal combination and number of drugs remains uncertain. Nagawawa et al. and Zweijpfenning et al. investigated these questions in two randomised controlled trials exploring treatment regimens for Mycobacterium avium complex (MAC) infections, while Nguyen et al. summarised some of these questions in a meta-analysis. Nagawawa et al. compared an intermittent three-drug regimen to daily therapy, while Zweijpfenning et al. compared rifampicin or clofazimine as adjuncts to ethambutol and a macrolide. Tolerance levels for intermittent therapy were not significantly superior to those of daily therapy, while a clofazimine-ethambutol-macrolide regimen was non-inferior to one including rifampicin. Finally, Nguyen et al. conclude that a two-drug regimen may be a viable option for treating MAC infections.

Work-life balance is a real challenge for early career respiratory professionals striving to manage clinical responsibilities, research, teaching and professional commitments. In this collective reflection by members of the European Respiratory Society Early Career Member Committee, we openly explore our own experiences, struggles and lessons learned in the pursuit of balance. While some of us feel we have found a rhythm that works, many are still navigating fluctuating demands, blurred boundaries and long hours that spill into evenings, weekends and even holidays. Parenthood, changing roles and growing responsibilities have reshaped our priorities and tested our limits. Still, we remain deeply passionate about our work. Through honest discussion, we share personal strategies such as setting boundaries, using time-management tools and leaning on support networks, and highlight the emotional toll when the balance is lost. We also recognise that systemic change is needed: fairer compensation, cultural shifts around overwork, and structural support for young professionals. This article is both a reflection and a call to action: to take care of ourselves, to support one another and to shape a professional culture where wellbeing is valued as much as productivity. We hope our shared experiences resonate and offer encouragement to other early career respiratory professionals.

Tuberculosis (TB) burden concentrates in low-income settings and remains the leading global cause of death from a single infectious agent, despite that it is preventable and treatable. TB-associated lung diseases (TBALD), a broad range of respiratory abnormalities which can start before or during a TB episode, may increase morbidity. TBALD may persist after successful completion of TB treatment as post-TB lung disease (PTLD). PTLD varies in severity and is characterised by persistent respiratory symptoms and lung impairment that can significantly impact social activities, health-related quality of life, and long-term survival. Risk factors for PTLD include increasing age, smoking, HIV infection, delayed diagnosis, and poor socioeconomic conditions. Action to limit PTLD may be taken before TB develops through TB screening, early diagnosis and TB preventive treatment, during treatment of TB, and upon its completion. Early detection, clinical assessment, and tailored management (including smoking cessation, immunisation, addressing respiratory comorbidities, pulmonary rehabilitation and social protection) can mitigate impairment and disability. Healthcare providers and national programmes play a vital role through clinical follow-up, patient education, and integration of TBALD care into broader health and social protection services. Sustained funding and research are crucial for this and to develop new tools to enhance care.

Respiratory tract infections are common within the general population and present a significant burden on healthcare systems, particularly in people with predisposing conditions such as chronic respiratory diseases. While pharmacological interventions remain a cornerstone of treatment, nonpharmacological strategies play a complementary role in both management and prevention of these conditions. These approaches encompass a broad range of measures, including adequate nutrition and hydration, preventive practices, stress reduction, and respiratory physiotherapy. This review aims at providing a comprehensive overview of these non-strictly pharmacological strategies of support and prevention to be adopted in the care of patients with respiratory conditions.

This review brings together global data on bacterial, fungal, nontuberculous mycobacterial (NTM) and viral infections that complicate the course of individuals following the diagnosis of pulmonary or extrapulmonary tuberculosis (TB). It shows how residual structural lung damage (bronchiectasis, cavitation, residual fibrotic lesions) and persistent immune dysregulation create niches for pathogens, most notably Pseudomonas aeruginosa, Aspergillus spp., Mycobacterium avium complex and herpes zoster virus. Although bacterial infections in post-TB bronchiectasis are the most consistently documented, chronic pulmonary aspergillosis and NTM disease add substantial morbidity. Viral complications beyond herpes zoster and influenza remain poorly characterised, underscoring a critical evidence gap. In extrapulmonary TB survivors, organ-specific sequelae pose additional infection risks that are rarely quantified. Across all categories, inconsistent case definitions, under-utilisation of the 10th revision of the International Classification of Diseases coding, and lack of prospective cohorts have obscured the true burden of post-TB infections. The review concludes by calling for standardised diagnostic criteria, enhanced epidemiological tracking, and integrated post-treatment care pathways including preventive vaccinations to mitigate long-term health consequences in this vulnerable population.

TB is a complex multifaceted disease with varying presentations and complications. Antimicrobial treatment remains the mainstay of treatment of trachea-oesophageal fistula secondary to TB; however, invasive interventions can be considered for complex cases. https://bit.ly/4qvsMct.

E-cigarettes may cause pulmonary Langerhans cell histiocytosis. https://bit.ly/4nDDmM2.