Expert review of respiratory medicine最新文献

Introduction: Radon gas has been a declared human carcinogen for more than 30 years and has been causally associated with lung cancer. Studies have shown a linear relationship between residential radon exposure and lung cancer risk.

Areas covered: Initially, this risk was subjected to cohorts of underground miners and then in case-control studies in the general population.While the evidence on residential radon exposure and lung cancer risk is extensive, there is little evidence on occupational radon exposure in conventional workplaces. Studies estimating radon-attributed mortality and prevalence also consider only residential radon exposure.

Expert opinion: As individuals are also exposed to radon in the workplace, further studies should incorporate an integrated assessment of radon exposure, including both residential and occupational exposure.The European Council Directive established specifications for occupational exposure to radon, indicating the reference level and making it mandatory to measure radon in the workplace. EU countries have adopted national legislation incorporating this framework, some relatively recently. These regulations create an unprecedented situation for previously and currently exposed workers. It is important that the legislation on the determination of radon concentrations in the workplace is rigorously enforced and introduced in countries where this is not yet the case.

Introduction: Long COVID defines persistence of symptoms in patients that recovered from acute COVID-19 infections. This manuscript is a brief update on current thinking on long COVID and potential causes and consequences.

Areas covered: The extent of long COVID varies between patients with some 200 symptoms described and of different severities. Persistent inflammatory or persistent viral infections or both may be the cause of long COVID but sorting this out will take years.

Expert opinion: Long COVID is an unfortunate consequence of COVID-19 infection and it remains uncertain why some people are afflicted and others not and as with other infectious diseases, it may be both a function of the virus strain, the host or both. Direct organ damage during acute infection versus inflammatory mediated damage over time are important questions to address. The disease outcome and chronic sequelae are likely related to the strains of infectious agent and/or host immunity and genetic predisposition.

Introduction: In the era of precision medicine, liquid biopsy rapidly emerges as an integrative diagnostic tool to successfully stratify solid tumor patients in accordance with molecular fingerprinting. As the matter of fact, a plethora of analytes may be isolated from liquid biosources supporting the potential application of liquid biopsy in several clinical scenarios. Despite this promising role, liquid biopsy is drastically affected by low abundance of analytes in biological matrix requiring highly sensitive technologies, trained personnel, and optimized diagnostic procedures to successfully administrate this revolutionary diagnostic tool in clinical practice.

Areas covered: This review aims to investigate the recent advancements in technical approaches available to manage liquid biopsy samples, particularly focusing on their application in LC diagnosis and treatment.

Expert opinion: The rapidly evolving scenario of liquid biopsy-based approaches is revolutionizing clinical administration of lung cancer patients. Of note, the integration of genomic, epigenomic, and transcriptomic markers lays the basis for 'comprehensive' molecular fingerprinting of lung cancer patients. Here, the next-generation technologies are fundamental in molecular profiling in diagnostic routine biofluids.

Background: Two long-acting muscarinic antagonist inhaler fixed dose combinations (olodaterol/tiotropium (OLO/TIO) and vilanterol/umeclidinium (VI/UMEC)) have once-a-day dosing for managing chronic obstructive pulmonary disease (COPD). This study aimed to compare clinical effectiveness of these inhalers in terms of ability to prevent severe COPD exacerbations in a United States Medicare population.

Research design and methods: Using nationally representative Medicare data (2013-2019), we employed a new user, active comparator design among beneficiaries aged 65 years and older with COPD. The outcome of interest was time to first occurrence of a severe COPD exacerbation. To ensure comparability between the groups, we performed 1:3 (OLO/TIO:VI/UMEC) nearest neighbor matching based on their high-dimensional propensity scores.

Results: The study included 2,263 OLO/TIO new initiators matched to 6,789 VI/UMEC new initiators. The incidence rate of the first severe COPD exacerbation was 40.8 per 100 person-years among new initiators (39.9 per 100 person-years for OLO/TIO, 41.1 per 100 person-years for VI/UMEC). The adjusted hazard ratio of the time to first COPD exacerbation was 0.948 (95% Confidence interval: 0.813-1.105) for individuals initiating OLO/TIO versus VI/UMEC.

Conclusion: We did not find a statistically significant difference between the OLO/TIO and VI/UMEC new users in terms of time to first severe exacerbation among Medicare COPD patients aged 65 or older.

Introduction: Bronchoscopic lung volume reduction (BLVR) using one-way endobronchial valves (EBV) is a guideline therapy for patients with severe emphysema without interlobar collateral ventilation, based on solid results from multiple randomized clinical trials (RCTs). However, whether its efficacy and safety in real-world clinical settings are comparable to those observed in RCTs has not been fully investigated. Additionally, recent reports on EBV therapy have focused on specialized populations (e.g. very low FEV₁, very low D_LCO) that were not represented in the RCTs.

Areas covered: We have summarized the efficacy and safety of the publications on BLVR with EBVs in real-world settings and in specialized populations, and have discussed these findings in relation to the RCTs data.

Expert opinion: The benefits of BLVR with EBVs have effectively translated into real-world clinical practice with a tolerable safety profile. These benefits and acceptable safety profile were also observed in specialized populations not fully represented in RCTs. We believe it is crucial to establish a nationwide registry in each country to keep track of outcome for quality and consistency, and to have a multidisciplinary COPD team discussion in each treating institution to keep on ensuring the successful clinical practice of BLVR with EBVs.

Introduction: Patients with acute myeloid leukemia (AML) are at high risk of developing life-threatening complications. It is estimated that a quarter of adult patients diagnosed with AML will require admission to the intensive care unit (ICU) at least once during their disease. Acute respiratory failure (ARF) is the main reason for ICU admission and is associated with high mortality rates, depending on the etiology of ARF.

Areas covered: In this population, the high prevalence of severe pulmonary infections highlights the importance of immunosuppression caused by the disease and its treatment. In the early stages of the disease, in addition to pneumonia, which should be systematically sought, leukemia-specific lung involvement (leukostasis, leukemic pulmonary infiltration, and acute lysis pneumopathy) is an important cause of ARF in this population, representing up to 60% of cases. This review aims to help understand the pathophysiology and management of leukemia-specific lung involvement, based on the most contemporary literature.

Expert opinion: The number of AML patients requiring ICU care is expected to increase. AML patients admitted to the ICU for ARF have a high mortality rate, but survivors have encouraging long-term outcomes. Future research will focus on improving risk stratification, cytoreduction, oxygenation strategies, and diagnostic techniques for ARF.