Expert review of respiratory medicine最新文献

Introduction: Pulmonary arterial hypertension (PAH) is a progressive disease characterized by the remodeling of pulmonary circulation, leading to increased pulmonary vascular resistance (PVR) and right ventricular (RV) overload. While the right heart may initially compensate, many patients ultimately face right heart failure and higher risk of mortality. Significant progress has been made in RV management, including advancements in molecular understanding, development of monitoring tools, and the exploration of new therapeutic pathways.

Areas covered: A comprehensive literature search (January 2000-present) was conducted using PubMed and Embase. Search strategies focused on Pulmonary Arterial Hypertension and the Right Ventricle, incorporating specific concepts such as RV-pulmonary arterial (RV-PA) coupling and noninvasive assessment methods, including Echocardiography (2D and 3D) and Cardiac Magnetic Resonance (CMR).

Expert opinion: The use of appropriate parameters to identify cardiac function deterioration is crucial for monitoring PAH patients. In this regard, imaging tests and new parameters have increasingly demonstrated added value when combined with traditional tools. This review highlights the central role of the RV in PAH pathophysiology and progression. We present and discuss noninvasive imaging methods for RV assessment, focusing on summarizing recent studies that support the use of noninvasive measures to evaluate RV-PA coupling and right systolic function.

Background: Early diagnosis of lung cancer is crucial due to often delayed symptoms. While resilience helps patients cope with treatment, its impact on symptom severity and quality of life at diagnosis is not well understood. This study explores how resilience at diagnosis may affect clinical progression in lung cancer patients.

Research design and methods: This observational study with a 3-month follow-up included 95 patients admitted for lung biopsy. Participants were classified based on the Brief Resilience Scale (low resilience < 3.00). Main variables included symptom severity, functional status, and health-related quality of life. Patients were assessed at the time of biopsy and again at 3 months.

Results: The 34.73% of patients presented low resilience and the 65.26% good resilience. Patients with low resilience presented significantly more respiratory symptoms (p < 0.001), and sleep disturbances (p = 0.05), added to poorer functionality and quality of life (p < 0.001) than those with good resilience. Three months after the biopsy, the good resilience group kept showing lower symptom severity (p < 0.05), better functionality (p < 0.001) and quality of life (p < 0.001) than low resilience patients.

Conclusion: Resilience appears to play a protective role in the clinical course of lung cancer and may be a valuable factor to consider in patient management strategies.

Introduction: Childhood asthma is a significant public health challenge in low- and middle-income countries (LMICs), with a high clinical and economic burden due to increased mortality, disability, and healthcare costs. Although numerous studies have been published assessing the economic burden of childhood asthma, most of these studies have focused on the financial burden of asthma in high-income countries.

Areas covered: This narrative review aims to identify studies that report the economic burden of childhood asthma in LMICs. We extracted the reported asthma-related costs, the type of institution where the study was conducted, the method of cost calculation, the proportion of direct costs to total costs, the leading direct cost items, and the main cost drivers, if reported, from the identified studies.

Expert opinion: This review highlights the high economic cost of childhood asthma in LMICs and provides an opportunity to rethink asthma management. Future strategies should prioritize prevention, ensure universal access to medicines, and incorporate cost assessment. A more proactive and integrated approach, combining a substantial primary care infrastructure, digital health interventions, and financial protection mechanisms, is crucial to reducing the economic burden of asthma and improving health outcomes for children in LMICs.

Background: Excessive central airway collapse can significantly impact quality of life and put patients at risk of respiratory complications. For patients with moderate or mild symptomatic disease, or those who are not candidates for surgical approaches, limited treatment modalities have been described for management of ECAC. However, case reports support the use of endoscopic approaches, specifically, laser-assisted tracheobronchoplasty. Here, we present a single-center experience of laser-assisted TBP (L-TBP) for the management of ECAC.

Methods: An IRB approved retrospective chart review was performed for patients who underwent L-TBP.

Results: A total of 16 L-TBP procedures were performed for six patients in our institution over the last 6 years. Four out of the six patients showed improvement in the amount of airway collapse seen on dynamic CT scan or awake bronchoscopy as compared to baseline imaging or bronchoscopy. Five out of the six patients who underwent L-TBP reported subjective improvement in their baseline symptoms of cough or dyspnea. Our data, while small, supports the fact that L-TBP may be an alternative effective means of treating ECAC in select patients with subjective improvements in their symptoms.

Conclusion: Further prospective trials are needed to validate this method as a means of treated ECAC.

Introduction: Type 2-high asthma (T2HA) accounts for most severe asthma morbidity and is driven by eosinophilic, IgE- and alarmin-mediated inflammation. Although five biologics are licensed, many patients remain symptomatic, corticosteroid-dependent or financially excluded.

Areas covered: PubMed, Embase, Web of Science, Scopus, Cochrane Library, EconLit, ClinicalTrials.gov and WHO-ICTRP were searched (1 January 2005 - 30 June 2025). Evidence from randomized trials, economic evaluations and translational studies on biologics, small-molecule drugs, cell-based and microbiome-directed interventions was synthesized across four domains: late-stage attrition, ultra-long-acting biologic limitations, slow small-molecule progress, and cost - access barriers. Durability, pediatric data and OCS-sparing potential were also examined.

Expert opinion: Phenotype-guided biologics have replaced corticosteroid escalation after two decades of research; nevertheless, plateaus in effectiveness, uncertain long-term safety profiles, and exorbitant costs persist. Future progress will depend on value-based pricing that facilitates global adoption, adaptive biomarker-anchored clinical trials, rational combination or bispecific therapeutics, and rigorous post-marketing surveillance of cell-based and microbiome-directed therapies. Delivering sustainable, equitable management of T2HA necessitates the coordination of scientific, regulatory, and economic mechanisms rather than focusing on increasingly narrow cytokine targets.

Introduction: Pulmonary toxicity induced by immune checkpoint inhibitors (ICIs) has a variable incidence and a high index of suspicion is necessary in order to enable a timely approach. There are few studies on the actual epidemiology and specific outcomes of pulmonary toxicity associated with this treatment. The aim of this study is to assess the frequency, characteristics and outcomes of lung injury induced by ICIs.

Methods: We conducted a systematic review applying predefined inclusion and exclusion criteria. A total of 7 studies were included.

Results: ICI-induced pneumonitis is a relevant toxicity, with an incidence ranging from 1% to 7%. The risk is higher with anti-PD-1 than with anti-PD-L1 agents, with observed OR of 4.53 for Nivolumab, 3.56 for Pembrolizumab, 2.48 for Atezolizumab and 20.16 for Durvalumab. Pulmonary toxicity is more frequent in gastrointestinal, colorectal, breast, renal cancer and advanced-stage non-small cell lung cancer, particularly when histology is squamous, there is high PD-L1 expression and in patients without prior treatments.

Conclusion: This systematic review provides an updated synthesis of the available evidence on ICI-associated pneumonitis, with particular attention to incidence, risk factors and progression. It contributes to outlining the profile of this adverse effect and identifying priority areas for future research.

Prospero protocol registration identifier: CRD420251039825.

Introduction: Severe eosinophilic asthma is a distinct asthma phenotype that is characterized by elevated blood eosinophils, frequent exacerbations and dependence on treatment with systemic corticosteroids. The development of Mepolizumab, a monoclonal antibody that targets Interleukin 5, has significantly transformed the therapeutic approach of patients with severe eosinophilic asthma.

Areas covered: This review explores the clinical development, efficacy, effectiveness and safety profile of mepolizumab. It also discusses emerging evidence on mepolizumab's role in achieving clinical remission and modifying airway remodeling. A literature search was conducted using PubMed database for articles published before June 2025, including randomized controlled trials, observational studies, and mechanistic investigations.

Expert opinion: Personalized medicine is an emerging field in treatment of severe eosinophilic asthma with the development of biologic agents. Mepolizumab has shown significant benefits in patients with severe eosinophilic asthma (reducing asthma exacerbations, improving quality of life and lung function), while remission has emerged as a treatment goal in some patients. The impact of mepolizumab in airway remodeling suggests its use as a disease modifying therapy not just as a symptom controller.

Background: Indwelling pleural catheters (IPCs) are commonly used for managing recurrent pleural effusion, yet standardized techniques for their placement are lacking. This study aimed to establish a consensus on IPC placement technique through a modified Delphi method.

Research design and methods: A three-round online-based survey was conducted among 22 experienced interventional pulmonologists in the United States. Consensus development involved identifying procedural domains from established interventional pulmonology curricula, refined into modules on pre-procedure preparation, technique, and post-procedure care. The survey included demographics, IPC placement preferences, and evaluation of procedural steps. Consensus was defined as an average numerical rating score ≥4 out of 5.

Results: Sixteen physicians completed all three survey rounds. Consensus was achieved on various aspects including pre-procedure preparation, choice of site, sterile preparation, Seldinger technique, tunneling, catheter insertion, securing catheter, and post-procedure care. There were divergences in the routine use of prophylactic antibiotics and screening of intercostal artery using linear ultrasound with doppler. The proposed steps encompass comprehensive IPC placement guidelines.

Conclusion: This study presents a standardized approach for IPC placement derived from expert consensus, addressing variability in practice and promoting procedural safety. These guidelines serve as a foundation for future research and practice refinement in IPC placement.

Introduction: The airway epithelium is composed of different cell types and acts as a physical barrier preventing pathogens, allergens, and microbes from entering the lungs. The recent investigations on epithelial barrier dysfunction-related mechanisms have provided a new perspective to look at asthma pathobiology.

Areas covered: In this review, we aim to describe the evidence related to epithelial barrier dysfunction and the 'traditional' asthma biomarkers: eosinophils, FeNO, IgE, cytokines, and epithelial barrier dysfunction in order to explore potential connections, inflammatory pathways, potential new therapeutic targets and to identify novel clinical profiles of asthma patients expressing an epithelial-driven disease.

Expert opinion: Although the existence of an 'epithelial-driven' profile in asthma is supported by pathobiological evidence, its identification on a clinical ground is still challenging and lacks specific biomarkers. However, by integrating the traditional hallmarks of type 2 inflammation with the clinical evidence of an impaired environment-host interaction, the relevance of epithelial barrier dysfunction as a predominant driver of airway immunity reshaping can be suspected. It has an important impact on treatment selection and overall management in the light of a precision medicine approach.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a substantial health-economic burden. Although mucociliary dysfunction is a key pathophysiological feature linked to adverse outcomes, the implication of computed tomography (CT)-identified mucus plugs in hospitalized patients with AECOPD remains unclear.

Research design and methods: This retrospective cohort study included 508 patients. Mucus plugs were assessed on the first chest CT scans after admission. Logistic regression analyses were employed to investigate the association of mucus plugs and hospitalization outcomes. The predictive performance was evaluated using receiver operating characteristic (ROC) analysis.

Results: Mucus plugs were observed in 179 (35.20%) patients and were independently associated with both prolonged length of stay (LOS) (adjusted odds ratio [OR], 1.85; 95% CI, 1.14-3.03; p < 0.05) and increased hospitalization costs (adjusted OR, 1.63; 95% CI, 1.05-2.54; p < 0.05). It also demonstrated considerable predictive value, with area under the curve (AUC) values of 0.780 and 0.811 for the respective outcomes.

Conclusion: Mucus plugs are significantly associated with prolonged LOS and increased hospitalization costs in AECOPD, highlighting their utility as practical imaging biomarkers for risk stratification and clinical management.