Expert review of respiratory medicine最新文献

Background: The aim of this study was to evaluate and characterize the alteration in mechanosensitivity in Long COVID haulers as well as its impact on patients' functionality and quality of life.

Research design and methods: In this study there were two groups: a group of Long COVID haulers and a group of healthy controls matched for age and sex. The mechanosensitivity clinical profile and peripheral nerve mechanosensitivity were evaluated. The mechanosensitivity clinical profile included the functionality and quality of life (World Health Organization Disability Assessment Schedule 2.0, Patient-Reported Outcomes Measurement Information System, EuroQol-5 Dimensions) and neural mechanosensitivity (Leeds Assessment of Neuropathic Symptoms and Signs). The peripheral nerve mechanosensitivity included neurodynamic tests (median, radial, ulnar, slump test and straight leg raise).

Results: A total of 64 patients were included in the study (Long COVID haulers group n = 33, healthy controls group n = 31). Long COVID haulers group obtained significantly worse results in functionality (p < 0.001), quality of life (p < 0.001), neural mechanosensitivity (p < 0.001) and peripheral nerve mechanosensitivity (p < 0.001).

Conclusions: Long COVID haulers have significant alterations in neural mechanosensitivity, contributing to a greater degree of functional impairment and poorer quality of life.

Introduction/objectives: This systematic review aimed to summarize the evidence on the effect of the fixed-dose combination of tiotropium/olodaterol (Tio/Olo 5/5 μg FDC) on exercise-related outcome measures.

Methods: We included randomized clinical trials (RCTs) from four databases that investigated the effectiveness of Tio/Olo 5/5 μg FDC on exercise tolerance, breathlessness, lung function, and physical activity from inception to October 2024.

Results: Findings from eight RCTs indicated that Tio/Olo 5/5 μg FDC was superior to Tio 5 μg or placebo for the following outcomes: exercise tolerance [Tio 5 μg: 3 RCTs, mean difference (MD) = 16.6 m, 95% CI: 5.2-28.1, p < 0.001], exercise endurance time [Placebo: 2 RCTs, SMD = 0.29, 95% CI: 0.19-0.39, p = p < 0.001], inspiratory capacity [Tio 5 μg: 3 RCTs, MD = 0.13 L, 95% CI: 0.07-0.19, p < 0.001], and forced expiratory volume in 1 second (FEV₁) [Tio 5 μg: 4 RCTs, MD = 0.12 L, 95% CI: 0.11-0.14, p < 0.001; Placebo: 2 RCTs, MD = 0.33 L, 95% CI: 0.3-0.35, p < 0.001], with no effect on physical activity levels.

Conclusion: Tio/Olo 5/5 μg FDC compared to Tio 5 μg or placebo may improve exercise tolerance and lung function, but not physical activity levels in COPD.

Protocol registration: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): number CRD42024598553.

Introduction: Interstitial lung disease (ILD) is a heterogenous, chronic, progressive lung disease characterized by thickening and scar fibrosis of lung tissue, interstitial alveolar damage, severe airways limitations, and impaired gas exchange which leads to breathlessness and fatigue.

Areas covered: Based on the available literature, only a few studies were identified that examined social determinants of health (SDOH) in the early diagnosis of ILD. The findings highlighted that those patients from low socioeconomic status and highly deprived communities had greater barriers in accessing healthcare, delayed diagnosis of ILD, and receiving lung transplant surgery. We discuss the challenges encountered by both patients and physicians for early diagnosis and suggest potential strategies to identify and accelerate treatment of patients with ILD.

Expert opinion: SDOH exerts substantial burdens upon patients with ILD. Delays in the diagnosis of ILD are associated with increased disease burden, elevated stress, anxiety, depression, frequent acute exacerbations, and premature death. SDOH heavily affect patients from low socioeconomic status and disadvantaged communities. Innovative strategies are required to address healthcare disparities on early diagnosis and treatment of ILD. Thus, patients with ILD and with identified SDOH may need dedicated additional support to improve care and focused areas for future research.

Introduction: Poor asthma control in pregnancy is associated with worse maternal and fetal outcomes. Despite this, many patients and providers opt not to continue treatment in pregnancy, largely due to fear of teratogenicity. The goal of this review is to inform providers about the safety of asthma medication in pregnancy as well as strategies for encouraging patients to adhere to these medications.

Areas covered: To prepare this narrative review article, we performed a database search using PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar to obtain a broad range of clinical studies, systematic reviews, and meta-analyses related to asthma management during pregnancy. Search terms included asthma, pregnan*, treat*, therap*, manage*, and comorbid* with Boolean operators used to refine the search. Studies were limited to those published in the English language from 2000 to 2025.

Expert opinion: Most classes of medications used to treat asthma have reassuring safety data for use in pregnancy. Additional data are needed to assess the use of biologics in pregnancy, which have become a cornerstone of management for non-pregnant patients with severe asthma. Routine visits with providers and identifying treatable traits can also improve outcomes in these patients.

Introduction: Chronic obstructive pulmonary disease (COPD) represents a significant global health burden. This review addresses the critical need for early identification and intervention by investigating the current research landscape in the early stages of the disease.

Areas covered: This review synthesizes the literature on the definitions, epidemiology, diagnostic approaches, prognosis, and management strategies for early COPD states, including preserved ratio impaired spirometry (PRISm), pre-COPD, young COPD, and mild COPD. A comprehensive literature search was conducted in PubMed and Web of Science up to October 2024.

Expert opinion: Experts believe that while conceptualizing early COPD offers transformative potential, progress is hampered by ambiguous diagnostic criteria and limitations in biomarkers. Future efforts should prioritize precision prevention through deep phenotyping and technological integration, acknowledging the risk of disparities.

Introduction: Asthma and fertility represent two health-related challenges for women of reproductive age. Women with asthma experience prolonged time of pregnancy and an increased likelihood of requiring fertility treatment.

Areas covered: While evidence on the association between asthma and pregnancy loss is conflicting, pregnancy itself is associated with additional risks of maternal and fetal complications. However, well-controlled asthma reduces these risks, underscoring the critical importance of proper management according to generally accepted asthma treatment guidelines. Age influences not only fertility but also the control of asthma during pregnancy, and increasing age correlates with a higher likelihood of uncontrolled asthma and exacerbations during pregnancy. Although systemic corticosteroid exposure during the first trimester may be associated with risks, the consequences of uncontrolled asthma and hypoxemia pose greater threats to fetal well-being and should therefore be administered according to guidelines if required.

Expert opinion: This review explores the relationship between asthma, fertility, and pregnancy outcomes, emphasizing the importance of asthma control and medication adherence. Practical recommendations are provided for women with asthma planning pregnancy, along with proposed future research directions to improve understanding and care in this population. In conclusion, women with asthma should be encouraged to plan pregnancies earlier in life, given the impact of age on fertility and asthma-related risks. While some may experience pregnancy loss, asthma does not reduce overall offspring numbers. Effective asthma management is essential to ensuring the health and well-being of both mother and fetus.

Introduction: To evaluate the efficacy and safety of Rituximab (RTX) in the treatment of pulmonary hypertension (PH) in patients with connective tissue diseases (CTDs).

Methods: A systematic review of the published literature was performed according to the PRISMA guidelines. Eligible articles were clinical trials, cohort studies, case series, and case reports of adult patients with CTD-PH treated with RTX. The selected languages were English and French.

Results: Six studies fulfilled the selection criteria and two of them were prospective. Most patients were from the U.S.A. and Russia. The predominant sex was female (85.9%), and the age of the included patients ranged from 29 years to 67 years. PH was confirmed by right heart catheterization in 3 studies. The CTDs associated with PH were systemic sclerosis (3 cases), adult-onset Still's disease (one case), systemic lupus erythematosus (one case) and mixed connective tissue disease (one case). The mean number of infusions was 4.2. The mean follow-up period across all studies was 18.3 months. Clinical and paraclinical parameters before and after RTX infusions were evaluated and showed improvement. RTX for the treatment of CTD-PH appeared to be well tolerated.

Conclusions: RTX seemed to be effective and safe in the treatment of CTD-PH.Systematic review registration: PROSPERO, ID: CRD420251037839.

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder that arises in individuals with asthma or cystic fibrosis due to an exaggerated immune response to Aspergillus fumigatus. It leads to mucus plugging, recurrent exacerbations, and progressive bronchiectasis. Despite established diagnostic criteria, ABPA remains underdiagnosed, primarily due to its overlap with severe asthma and limited clinical awareness. Evolving insights into immunopathogenesis and the emergence of targeted therapies have begun to transform the management of ABPA.

Areas covered: We discuss the current evidence on immunopathogenesis, treatment, and monitoring of ABPA in asthma. The review covers established and emerging therapies, including systemic glucocorticoids, oral triazoles (such as itraconazole), inhaled antifungals, and biological agents. We provide practical guidance for initiating treatment based on disease phenotype and discuss treatment monitoring using clinical symptoms, serum biomarkers, chest imaging, and lung function tests.

Expert opinion: The management of ABPA is poised for a paradigm shift toward precision medicine. Future strategies will likely be driven by international registries, biomarker discovery using omics-based platforms, and the identification of endotype- and phenotype-specific treatments. Randomized trials comparing biologic therapies, combination approaches using antifungals and biologics, and the development of inhaled antifungal delivery systems are likely to reshape the management of ABPA.

Background: Fibrosing Interstitial Lung Diseases (F-ILDs) lead to reduced exercise capacity and quality of life. Pulmonary Rehabilitation (PR) exercise programs have shown potential in improving symptoms and functional capacity in these patients. This study aimed to compare the effectiveness of different PR exercise approaches in patients with F-ILDs.

Research design and methods: This randomized, three-arm controlled trial included F-ILD patients divided into three groups: hospital-based supervised(HGr), synchronized-online(SOGr) with live video calls, and video-based (VGr) with recorded exercise videos. All groups underwent an 8-week program combining aerobic and resistance training. Clinical parameters assessed included 6-minute walking distance(6MWD), modified medical research council dyspnea score(mMRC), respiratory function tests, Saint George Respiratory Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form(IPAQ-SF), fatigue severity scale (FSS), and muscle strength.

Results: Of the 75 patients, 65 completed the study, with comparable demographic and baseline characteristics. Significant improvements in 6MWD, mMRC, maximal inspiratory pressure, IPAQ-SF, SGRQ, and peripheral muscle strength were seen in all groups. Post-hoc analysis showed HGr had greater improvements in forced vital capacity and FSS compared to SOGr.

Conclusion: Hospital-based, synchronized-online, and video-based PR programs all improve clinical outcomes in patients with F-ILDs. However, supervised in-hospital PR yielded greater benefits in lung function and fatigue reduction compared to the online approaches.

Clinicaltrial registration: https://clinicaltrials.gov/study/NCT05166057.

Introduction: Predominantly antibody deficiencies (PADs) represent the most common inborn errors of immunity (IEIs), constituting over 50% of all IEIs detected globally. Compared to other IEIs, PADs are linked to a more favorable long-term prognosis and are typically diagnosed in adulthood. We analyzed the most recent literature on lung involvement in PAD using PUBMED Central.

Areas covered: PADs are characterized by their impact on the respiratory system, which results in significant morbidity and mortality due to the impairment of both humoral and mucosal immune responses. This impact leads to a broad spectrum of complications that could be infection-related, inflammatory, or neoplastic.

Expert opinion: Defined guidelines are unavailable, but a strict assessment of pulmonary status should be recommended in patients with characteristic immunologic patterns (low IgA serum level, reduced percentage of switched memory B cells, increased IgM serum levels, increased percentage of CD21 low B cells, autoimmune cytopenia, and splenomegaly).