Expert review of respiratory medicine最新文献

Introduction: Cardiopulmonary exercise testing (CPET) is a diagnostic-integrated tool for evaluating cardiovascular, ventilatory, and metabolic functional limitations in children with respiratory diseases. Recently, novel applications have emerged, revealing dynamic abnormalities that may go unnoticed in standard static cardiac and pulmonary function tests. Given its clinical importance and novel research findings, updated recommendations are warranted.

Areas covered: We conducted a narrative review based on a literature search up to April 2025. This review provides an update on the application of CPET in pediatric respiratory diseases, covering physiological differences to adults, non-traditional CPET metrics such as the oxygen uptake efficiency slope (OUES), tidal volume to inspiratory time ratio (VT/Ti), and recent reference values. Indications, contraindications, and standardized protocols are discussed, alongside emerging trends in CPET technology.

Expert opinion: CPET is a potent tool for assessing, evaluating, and diagnosing pediatric respiratory diseases. Standardized protocols, age-specific reference values, and novel CPET parameters enhance clinical utility. Future research should refine interpretation, integrate artificial intelligence for data analysis, and facilitate CPET for younger children.

Introduction: Type-2-high (T2-high) asthma remains the most prevalent phenotype of this chronic airway disease. Accumulating evidence implicates the gut-lung microbiome axis as the principal mechanism underlying T2-immune modulation, influencing disease trajectory and therapeutic efficacy.

Areas covered: Following Ferrari's narrative-review framework, a three-stage search of PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library and trial registries (2010-March 2025) was conducted. This review integrates a decade of human and animal investigations in genomics, transcriptomics, metabolomics, and microbiomics. It elucidates cooperative cellular networks in T2-high asthma, traces the hematogenous, lymphatic, and neural conduits conveying gut-derived metabolites the airways, and examines the roles of barrier integrity. The review also included dietary modulation strategies ranging from fiber enrichment and Mediterranean dietary patterns to excessive ultra-processed food intake.

Expert opinion: Near-term translation will pair ICS/LABA/biologics with diet/postbiotics and validated, low-biomass-aware multi-omic panels; adequately powered RCTs and contamination-controlled pipelines are prerequisites for routine care.

Introduction: Alcohol use disorder (AUD) represents a major public health issue that produces far-reaching physiological effects. AUD is an underappreciated, yet critical risk factor clinicians need to be aware of and screen for to integrate preventive and therapeutic strategies when dealing with pneumonia in this vulnerable population. This research paper investigates the link between AUD and pneumonia by examining both the elevated risk of lung infection and the intensified disease severity.

Areas covered: The available epidemiological data show that people with AUD experience elevated rates of both community-acquired and hospital-acquired pneumonia. This review examines the detailed mechanisms of AUD as suggested by current research findings. For this purpose, a comprehensive literature search was conducted in PubMed between 1785 and 2025. Open Evidence was also used as a search engine to look for specific papers addressing a specific question of interest.

Expert opinion: These studies indicate that alcohol consumption makes people more prone to infections through various mechanisms. Alcohol-related comorbidities exacerbate pneumonia outcomes, resulting in elevated hospitalization rates, intensive care unit (ICU) admissions, and patient deaths. This review emphasizes the need for combined healthcare strategies that treat substance use disorders together with measures to prevent infection risks to improve patient outcomes.

Introduction: Acute Chest Syndrome (ACS) is a serious and often fatal complication of Sickle Cell Disease (SCD). In the absence of specific biomarkers that indicate the development of ACS, diagnosis can be nebulous and difficult. In this narrative literature review, we examine the current evidence for novel biomarkers associated with acute and long-term propensity toward ACS.

Areas covered: A search focused on terms related to 'acute chest syndrome,' 'sickle cell anemia,' and 'biomarkers' was created and run by a medical librarian in MEDLINE (Ovid), Google Scholar, and Embase (Ovid). Four-hundred seven articles were found in the initial search. After duplicates removed and irrelevant studies excluded, 13 were included for final data extraction. Data extraction was completed by three authors and collated to form the final manuscript.

Expert opinion: Currently, ACS diagnosis remains a great challenge. The reviewed literature shows promise in both novel biomarkers like sputum IL-6 and alternative interpretations of routine studies including blood counts and inflammatory markers. Still, large, multicenter trials to validate reliable and specific markers for ACS remain elusive. Isolating a dependable, rapid, and widely available and affordable biomarker for ACS may help diagnose and change morbidity and mortality from one of SCD's most fatal complications.

Introduction: Physical deconditioning is common in adults with moderate-to-severe asthma, negatively affecting respiratory function, disease control and quality of life (QoL). Pulmonary rehabilitation may improve both functional and psychological outcomes.

Objective: This systematic review aimed to evaluate the effectiveness of rehabilitative interventions in moderate-to-severe asthma and to assess the methodological quality of the included studies.

Methods: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, PEDro, SCOPUS, and Web of Science following PRISMA guidelines. Eligible designs included randomized controlled trials (RCTs), quasi-experimental and observational studies. Risk of bias was assessed using PEDro scale and Risk of bias-2 (RoB2) for RCTs, ROBINS-E/ROBINS-I for non-randomized and observational studies.

Results: Thirteen studies (n. 1094 participants) were included. Outcome measures comprised Lung Function, Six-Minute Walking Test (6MWT), Asthma Quality of Life Questionnaire (AQLQ), and Asthma Control Questionnaire (ACQ). Aerobic training combined with breathing techniques improved exercise tolerance (6MWT: 39.62 m; 95% CI 18 to 123 m) and QoL; Inspiratory muscle training (IMT) showed additional functional benefits. Overall methodological quality ranged from low to moderate, with limitations related to heterogeneity and small sample sizes.

Conclusion: Aerobic training with breathing techniques appears beneficial for moderate-to-severe asthma. Further high-quality, large-scale RCTs are needed to confirm these findings.

Prospero registration: www.crd.york.ac.uk/prospero identifier is CRD420251024215.

Introduction: Thymic stromal lymphopoietin (TSLP) is an epithelial-derived cytokine shown to bridge innate and adaptive immunity, and orchestrates airway inflammation across both type 2 (T2)-high and T2-low asthma. Emerging evidence suggests that by functioning as an alarmin upstream of airway immune cells, TSLP integrates epithelial and immune signaling to initiate inflammation and structural remodeling, positioning it as a pivotal therapeutic target in asthma pathogenesis.

Areas covered: This review summarizes the current understanding of TSLP biology and its roles in both T2- high and T2-low inflammation. Clinical data from tezepelumab treatment and emerging next-generation anti-TSLP agents, including bispecific antibodies, receptor antagonists and inhaled formulation, are evaluated for their potential to transform asthma management.

Expert opinion: Targeting TSLP represents a paradigm shift in asthma therapy, offering efficacy across diverse inflammatory endotypes, however with greater benefit in T2-high patients. Next-generation anti-TSLP agents aim to enhance potency, durability and tissue specificity, and combine with other agents for bi-specific therapy. Despite this progress in clinical development, key challenges remain, including understanding isoform-specific functions, improving biomarker-based patient stratification and assessing long-term safety of TSLP inhibition. As research advances, TSLP inhibition is expected to evolve from the strategy of single cytokine blockade into a personalized multi-pathway approach.

Introduction: Patient self-inflicted lung injury (P-SILI) has been proposed as a contributor to lung damage during spontaneous breathing or partially assisted ventilation. P-SILI usually arises from excessive inspiratory efforts driven by abnormally elevated respiratory drive. Assessing respiratory drive and effort is therefore crucial for identifying patients at risk and guiding tailored lung-protective strategies.

Areas covered: This narrative review provides practical recommendations for the identification and management of patients at risk of developing P-SILI.

Expert opinion: Accurate assessment of respiratory drive and effort - using ventilator-derived parameters, esophageal manometry, diaphragm electromyography, and imaging modalities - is vital, though not yet standard in clinical practice. Management should aim to correct underlying causes of heightened drive, optimize sedation and ventilator settings, and apply advanced lung-protective interventions when appropriate. Future priorities include improving monitoring techniques, clarifying whether inspiratory effort or lung stress should be prioritized, and determining optimal timing for intubation. Balancing excessive and insufficient effort is essential, as both P-SILI and diaphragmatic disuse can worsen outcomes. Emerging imaging technologies may enhance real-time assessment of regional strain and effort. Ultimately, integrating physiological monitoring with individualized ventilatory management is fundamental to protect the lung while preserving respiratory muscle function and improving patient outcomes.

Introduction: Muscle weakness represents a significant clinical problem in chronic obstructive pulmonary disease (COPD). During exacerbations of COPD (ECOPD), inflammation, oxidative stress, malnutrition, disuse, hypoxia, and glucocorticoid (GC) levels increase and converge, further aggravating skeletal muscle impairment with GC signaling as a common denominator. No intervention currently exists that specifically prevents or counteracts GC-induced muscle weakness during ECOPD.

Areas covered: This review summarizes clinical and pre-clinical evidence on the role of GC signaling in muscle dysfunction during ECOPD. We discuss the underlying molecular mechanisms by which GCs drive muscle weakness, and critically evaluate emerging pharmacological strategies aimed at mitigating these effects. PubMed and Scopus were searched for peer-reviewed papers published before April 2025.

Expert opinion: GC-induced muscle weakness is an under-recognized but potentially modifiable contributor to muscle weakness in ECOPD. Particular promise lies in pharmacological interventions such as myostatin pathway inhibitors, selective androgen receptor modulators, and those inducing IGF-1-related protein synthesis. Dedicated translational and clinical research is urgently needed to evaluate these novel interventions in the setting of ECOPD. Effective countermeasures could preserve muscle mass and function, improve exercise capacity and recovery, shorten hospital stay, and lower the risk of recurrence, offering a new therapeutic opportunity in ECOPD management.