Expert review of respiratory medicine最新文献

Introduction: Despite optimal pharmacological treatment, patients with COPD often experience symptoms and report physical, mental and/or social limitations. This underlines the need for additional, non-pharmacological interventions, such as physical therapy, psychological support, nutritional counseling and occupational therapy. In this, allied healthcare professionals (AHPs) play a vital role as they bring specialized knowledge and skills to assess and, if needed, treat different aspects of the disease. Areas covered: A broad literature search was conducted to narratively summarize current evidence of allied healthcare, underlines the importance of interprofessional collaboration, including the role of patients, and highlights future perspectives.

Expert opinion: The evidence of the important role of AHPs in the assessment and treatment of COPD is robust. Unfortunately, allied healthcare is markedly underutilized in patients with COPD. Increasing referral rates to AHPs is essential to optimize COPD management. Collaboration, including the role of the patient, is essential to ensure comprehensive and holistic care, improve outcomes and enhance communication. In the future, AHPs will be challenged to dare to think beyond their own expertise and expand their scope.

Introduction: Respiratory viral pneumonias are a leading cause of severe respiratory failure and intensive care unit (ICU) admission worldwide. Although viral infection itself drives significant morbidity and mortality, secondary bacterial and fungal superinfections represent a critical 'double threat' in critically ill adults, exacerbating lung injury, prolonging organ dysfunction, and complicating antimicrobial management. Experience from the Influenza A (H1N1) pdm09 and SARS-CoV-2 pandemics highlights a persistent mismatch between low documented bacterial co-infection rates and widespread empiric antibiotic exposure, underscoring diagnostic uncertainty and antimicrobial stewardship challenges in the ICU.

Areas covered: This review examines the epidemiology, immunopathogenesis, and diagnostic approaches to bacterial and fungal superinfection in adult ICU patients with severe viral pneumonia. Evidence is synthesized from large ICU cohorts, pandemic data, and established consensus definitions for influenza- and COVID-19-associated pulmonary aspergillosis (IAPA, CAPA). The review discusses advances in molecular diagnostics, lower respiratory tract sampling, bronchoalveolar lavage - based mycology, and biomarker-guided strategies, with a focused literature search of ICU-specific studies.

Expert opinion: Bacterial and fungal superinfections, while infrequent, carry substantial clinical impact in severe viral pneumonia. A multimodal, ICU-adapted diagnostic strategy integrating pathogen detection with host-response assessment is essential to support timely therapy, enable antimicrobial de-escalation, and align superinfection management with stewardship principles.

Introduction: Airway clearance techniques (ACT) are a longstanding modality of treatment in many chronic respiratory diseases. Their aims are to counteract airway obstruction by mobilizing airway secretions and/or by limiting the airway collapse.

Areas covered: This review first outlines the physiological mechanisms underlying ACT. In a second part, it categorizes the ACT into seven distinct groups. These groups include both instrumental and non-instrumental ACT. Strategies such as physical activity and upper airway clearance techniques are also considered as ACT due to their complementary roles in mobilizing airway secretions.

Expert opinion: The lack of standardized definitions for airway clearance techniques (ACT) leads to significant differences in the clinical practice and effects because the variability in physiological mechanisms. Studies show that both manual and instrumental ACT are influenced by therapist-dependent factors such as applied force, duration of the application, and patient positioning. To ensure reproducibility and effective teaching, a single, physiologically grounded description of ACT is urgently needed.

Introduction: Central sleep apnea (CSA) affects up to one-third of patients with heart failure (HF) and is linked to sympathetic activation, arrhythmias, impaired quality of life, and worse prognosis. Understanding epidemiology, mechanisms, and evolving therapies is essential as management recommendations are rapidly changing.

Areas covered: This review synthesizes data retrieved from a PubMed database search on CSA prevalence across HF phenotypes, delineates pathophysiology, and appraises therapies. We performed a structured search for randomized trials, large observational studies, meta-analyses, and recent guidance, with focused appraisal of the latest statements from the American Academy of Sleep Medicine (AASM) and the European Respiratory Society (ERS).

Expert opinion: The field is shifting from one size fits all apnea-hyponea index (AHI) suppression to phenotype-guided care, prioritizing patient centered and cardiac outcomes. Integrating endotyping, remote monitoring, and HF co-management is key. Major gaps include optimal patient selection, long-term cardiovascular endpoints, and harmonization of guideline recommendations. If optimization of HF therapy and a continuous positive airway pressure (CPAP) trial fail to improve symptoms, adaptive servoventilation (ASV) becomes the preferred therapeutical option.

Introduction: PubMed was used for a literature search (1990-2025) on the minimally invasive surgical approaches for pneumothorax, which have evolved markedly, with video-assisted thoracic surgery (VATS) emerging as a preferred procedure. Systematic reviews of randomized control trials indicate that VATS is less invasive than traditional thoracotomy. Furthermore, uniportal VATS provides less postoperative pain and better cosmetic outcomes than thoracotomy. Currently, uniportal VATS seems preferred as the minimally invasive surgical approach for pneumothorax. New devices such as small-diameter thoracoscopes and forceps, which are used in uniportal subxiphoid VATS and uniportal subcostal robot-assisted thoracic surgery, may contribute to reducing the postoperative incidence of intercostal neuralgia and enhancing satisfaction with the cosmetic results.

Areas covered: The ideal surgical approaches for pneumothorax, referencing guidelines, and studies from various countries.

Expert opinion: This review explores various aspects of minimally invasive surgical approaches for pneumothorax. Uniportal VATS for pneumothorax via the intercostal approach is commonly performed worldwide and ensures high surgical quality. This review discusses what should be performed within the thoracic cavity to reduce the postoperative recurrence rate of pneumothorax, problems associated with thoracic adhesions that may be disadvantageous for pneumothorax patients in the future, and the latest surgical approaches that may become mainstream.

Introduction: The fibrotic interstitial lung diseases (f-ILD) are often progressive and debilitating lung diseases with significant symptom burden and impaired quality of life. Pulmonary rehabilitation (PR) has demonstrated improvements in dyspnea, physical function, and respiratory-related quality of life (RR-QoL) in patients with -f-ILD but had limited uptake and completion in real-world settings.

Areas covered: A literature review was completed on the impact and limitations of traditional PR in f-ILD, with additional perspective on the use of home-based approaches and implementation of health coaching. Barriers to traditional center-based PR programs include patient and systems-based factors such as unawareness of benefit, emotional or psychological distress, and limited access. Home-based PR may address these limitations by removing travel barriers, increasing access with remote supervision and monitoring, and promoting social support by connecting care with familiar settings. Studies involving home-based PR in ILD have shown promise with improving functional and quality of life outcomes and high compliance rates. Health coaching is a collaborative paradigm for fostering behavior change and has demonstrated positive impact in the management of chronic diseases.

Expert opinion: A combination of health coaching with home-based PR may address ongoing challenges of PR uptake and compliance as well as expand PR as a holistic and comprehensive intervention.

Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms causing persistent, often progressive airflow obstruction. Strength training is a therapeutic option to prevent and/or reverse muscle dysfunction in COPD patients. Objective: to analyze the literature on the effects of strength training in COPD patients.

Methods: A systematic review from the last ten years was conducted in August 2024 across PubMed, Scopus, WOS, Medline and CINAHL databases. The search included studies examining resistance training for upper and lower limbs. Methodological quality was analyzed using the PEDro scale and the RoB2 was used for risk of bias.

Results: Six randomized controlled trials were eligible for inclusion, obtaining an excellent or good methodological quality. Most repeated variables were exercise capacity, quality of life and muscle strength, finding statistically significant positive results in all of them.

Conclusions: Strength training appears to be safe and effective for COPD treatment, with improvements in exercise capacity, activities of daily living, muscle strength, lung function, quality of life and inflammatory levels. However, scientific evidence on this topic is scarce, and future high-quality, long-term studies are necessary to establish standardized protocols and assess the sustained benefits of strength training in COPD patients.Protocol registration: Identifier is CRD42024572717.

Introduction: Airway management is one of the most important interventions performed by paramedics in the prehospital setting. While the standard of care for over 40 years, multiple studies highlight pitfalls associated with prehospital airway management in adults. Considerably less research describes prehospital airway management in children.

Areas covered: We searched PubMed for articles from 2000 to present using the keywords 'children,' 'airway management,' 'intubation intratracheal,' 'Emergency Medical Services,' and 'paramedic.' Studies highlight the pitfalls of adult prehospital endotracheal intubation such as tube misplacement and dislodgement, multiple and failed insertion attempts, interruptions in chest compressions, and inadvertent hyperventilation. Multicenter clinical trials including the PART and Airways-2 trials support the use of newer supraglottic airways as potential alternatives to intubation in adults. Only limited data describe prehospital airway management in children, including only one clinical trial performed 25 years ago.

Expert opinion: New studies are needed to guide paramedic pediatric airway management practices. The Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) is an ongoing multicenter clinical trial that will provide critical new knowledge to guide prehospital pediatric airway management practices.