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.

Background: Respiratory Syncytial Virus (RSV) is a major cause of severe respiratory illness in infants, older adults, and immunocompromised individuals. However, data on physicians' knowledge and attitudes toward RSV and its prevention in Türkiye are limited. The aim of this study was to evaluate the knowledge and attitudes of physicians in Türkiye about RSV.

Research design and methods: A cross-sectional online survey was conducted among physicians in Türkiye between October and November 2024.

Results: A total of 1270 physicians (median age: 35; 62.44% female) participated, 30.5% of whom specialized in Infectious Diseases (ID). While 43.54% correctly identified RSV symptoms, only 15.9% recognized high-risk groups, and 49.7% were familiar with associated clinical conditions. ID specialists had significantly greater knowledge of symptoms (p = 0.015) and complications (p < 0.001) compared to other physicians. Overall, 51.57% perceived the national RSV burden as high. However, only 40.31% were aware of prevention tools. Although 51.88% knew about FDA-approved RSV vaccines, just 21.54% knew they were not yet available in Türkiye. Among vaccine-aware participants, most would recommend it to elderly (85.28%), while fewer supported maternal vaccination (58.87%).

Conclusions: These findings reveal that despite higher knowledge among ID physicians, overall awareness of RSV and its prevention is inadequate.

Introduction: Lung ultrasound has consolidated over the years its valuable role in supporting routine clinical activity in different settings. Every disease that alters peripheral airspace geometry can generate a superficial structure with low impedance mismatch which can be capable of trapping ultrasound waves within reflective interfaces.

Areas covered: Qualitative approaches to the description of horizontal and vertical acoustic artifacts have been adopted by physicians for a long time with the consequence of poor diagnostic accuracy and reproducibility. Semi-quantitative methods try to fill the gaps in the operator's qualitative assessments. Finally, quantitative approaches aim to overcome the interpretative biases of visual evaluations of the ultrasound image through measures related to the characteristics of the acoustic traps at the level of the pleural line.

Expert opinion: Current research on the genesis of vertical artifacts and their contribution to the characterization of respiratory diseases is benefiting from the synergies among physicians, engineers, and physicists. The 'acoustic trap' hypothesis, with its effects on the generation of vertical artifacts resulting from the morphology of the trap itself and transmission imaging parameters, represents one of the fronts of ongoing scientific research on innovative methods for the quantitative characterization of lung parenchyma.

Introduction: Traditional dogma suggests that acute pulmonary embolism (PE) occurs rarely in children <18 years. However, in the emergency department (ED) setting, the frequency of PE diagnosis in children with signs or symptoms that raise suspicion for PE is unknown. This uncertainty is fueled by the lack of prospective studies of PE exclusion and diagnosis in children. Children occasionally die unexpectedly from an acute PE that was missed during the initial evaluation by a physician. However, over-testing also carries risks.

Areas covered: This review addresses the risks of over-testing and radiation exposure, and the use of clinical criteria to assess the pretest probability of PE to decide when to test for this condition in children. We discuss what is known about the theoretical test threshold and the unstructured and structured pretest probability of PE assessment in children. Additionally, we review the theory behind the D-dimer assay and the current literature that has reported the diagnostic accuracy of the D-dimer for PE in children.

Expert opinion: We propose a hypothetical clinical algorithm that incorporates the use of a prediction rule that relies upon both unstructured and structured pretest probability assessments, coupled with the D-dimer to safely rule out the diagnosis of PE in children without the use of radiation.

Introduction: Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a common cause of death in humans worldwide. The slow growth rate of Mtb (~20 hours) makes progress in research slow and diagnosis difficult.

Areas covered: Imaging technologies that can quantify viability and infectious load can have a profound impact on progress toward new therapeutics and vaccines and allow rapid diagnosis. Although imaging can quantify bacterial loads throughout an entire animal in real-time, sensitivity is a key limitation. Fluorescent and bioluminescent recombinant strains have been used within the TB field and in other bacteria but have a threshold of ~10³ bacteria in mice. Reporter enzyme fluorescence (REF) is a new and very sensitive Mtb imaging technology that uses BlaC, a highly specific surface-localized β-lactamase, in combination with fluorogenic or bioluminescent probes. As such, REF can reduce the threshold to 10-100 bacteria in vivo and detect 10 bacteria within 10 minutes in vitro.

Expert opinion: Recombinant reporter systems for imaging bacteria should continue to improve and may reach similar thresholds, but at present, REF remains the most sensitive approach. Furthermore, new more sensitive probes can be readily developed, suggesting that REF will ultimately allow detection of single bacteria in an infected host.

Introduction: Telemedicine is defined as the delivery of healthcare from a distance using electronic information and communication technology. Patients with interstitial lung disease (ILD) were among the early recipients of such remote healthcare.

Areas covered: We reviewed this contemporary field of telemedicine-driven therapeutic interventions in ILD patients. PubMed was used for literature search, focusing on research articles, international guidelines, and so on.

Expert opinion: The initial stage of telemedicine for ILD patients was mainly focused on subjects already diagnosed and was therefore adopted for monitoring purposes. As technology developed, pulmonary rehabilitation (PR) also became amenable to remote delivery to evaluate therapeutic efficacy of home-based interventions. Physicians are enabling ILD patients to undergo therapeutic PR at home, with the support of telemedicine. This approach is being tested across various ILD diseases, showing promising results. Telemedicine presents an opportunity to reduce the socioeconomic burden on both patients and caregivers during therapeutic rehabilitation of ILD patients. This potential, however, is contingent upon successfully addressing challenges like legal issues and ensuring high user adoption.

Introduction: Children with chronic suppurative or inflammatory lung diseases, including cystic fibrosis (CF), non-CF bronchiectasis (NCFB), chronic suppurative lung disease (CSLD), and primary ciliary dyskinesia (PCD), experience recurrent infection and persistent neutrophilic airway inflammation that together drive progressive lung injury. Prophylactic antibiotic strategies have therefore been explored to interrupt this infection - inflammation cycle, encompassing both pathogen-specific approaches and longer-term anti-exacerbation or immunomodulatory therapies.

Areas covered: We review clinical trials, observational studies, and guideline recommendations evaluating prophylactic antibiotic use in chronic pediatric lung disease. A targeted literature search using PubMed was conducted, focusing on macrolide and non-macrolide prophylactic strategies in children under 18 years of age, disease-specific outcomes, antimicrobial resistance, and stewardship considerations across pediatric respiratory disorders.

Expert opinion: Evidence supporting antibiotic prophylaxis varies substantially by disease and clinical context. We propose a framework for selective, time-limited use of prophylactic antibiotics, emphasizing individualized risk - benefit assessment, regular reassessment of efficacy, and integration within antimicrobial stewardship paradigms.

Introduction: Novel targeted therapies and immune checkpoint inhibitors have transformed the therapeutic landscape of lung cancer, significantly improving survival outcomes. However, these new therapeutic agents are accompanied by a broad spectrum of adverse events. Pulmonary adverse events, particularly pneumonitis, represent a clinically significant concern due to their potential severity and impact on treatment continuation.

Areas covered: This review summarizes current evidence on pulmonary toxicity associated with tyrosine kinase Inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), with a primary focus on lung cancer. A comprehensive literature search of PubMed and recent clinical trial data was undertaken to investigate the overall incidence and management strategies for pneumonitis and related pulmonary events linked to these therapies. While TKIs and ICIs have revolutionized cancer therapy, pulmonary toxicities, though uncommon, can be life threatening.

Expert opinion: Improved understanding of underlying mechanisms, enhanced pharmacovigilance and thorough assessment of risk factors prior to drug- administration are essential to mitigate risks. Clinicians should maintain a high index of suspicion for pneumonitis in patients receiving ICIs or TKIs, and suspected cases should be promptly referred to specialized centers with expertise in therapy-related pulmonary complications.

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: 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, underline the importance of interprofessional collaboration, including the role of patients, and highlight 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.