Expert review of respiratory medicine最新文献

Introduction: Asthma is one of the most common noncommunicable diseases, raising serious concerns about asthma-related deaths globally. Studies have reported safety concerns with short-acting beta-agonists (SABAs) monotherapy. SABA overuse contributes significantly to the healthcare burden in the Philippines. Despite Global Asthma Network's years-long advocacy for equal access to essential medicines at affordable cost, the uptake of international healthcare policies is limited in most low- and middle-income countries, including the Philippines.

Areas covered: We reviewed synthesis of targeted nonsystematic literature searches on prevalence of asthma and asthma-related mortality, SABA overreliance and its adverse events, alternatives to SABA, patient referral, and multidisciplinary team (MDT) approach for asthma management. We describe regional challenges and recommendations for improving asthma care through continued multisectoral collaboration.

Expert opinion: Use of medications like inhaled corticosteroid-formoterol combinations may aid in reducing adverse events including severe exacerbations, hospitalizations, complications from oral corticosteroid use, and long-term treatment costs. Raising patient awareness about preventive measures, proper inhaler techniques, and medication adherence can mitigate burden of uncontrolled asthma. Improving access to asthma medications alongside developing treatment algorithms and referral pathways (including MDT) for primary care physicians will pave the way for optimal asthma care in LMICs, including the Philippines.

Introduction: We have carried out a systematic review of the literature (SRL) and a meta-analysis (MA) to answer: 1. Validity of the nicotine metabolite ratio (NMR) in improving the effectiveness of pharmacological treatments (PT) for smoking cessation (SC). 2. Validity of the NMR to improve the safety of the use of these PT? and 3. Validity of NMR in improving adherence to these PT?

Method: We carried out an SRL (six databases) and an MA for responding to the questions.

Results: PT for SC (any treatment) is more effective in smoking subjects with slow NMR compared with fast NMR. Varenicline (VR) is equally effective in fast and slow NMR (RR 1.04 [CI 95% 0.75, 1.44]). When we compared those smokers who were treated to quit smoking with VR or nicotine replacement therapy (NRT) in fast metabolizers, we found that abstinence was in favor of those who were treated with VR (RR 1.40 [CI 95% 1.02, 1.91]). Those who were treated to quit smoking with NRT presented better results in slow Metabolizers (RR 0.70 [CI 95% 0.58, 0.83]). NMR increases the safety and adherence of treatments.

Conclusions: We suggest that NMR is a good biomarker in the personalization of smoking cessation.

Introduction: Pulmonary endoscopy occupies a central role in Interventional Pulmonology and is frequently the mainstay of diagnosis of respiratory disease, in particular lung malignancy. Older techniques such as rigid bronchoscopy maintain an important role in central airway obstruction. Renewed interest in the peripheral pulmonary nodule is driving major advances in technologies to increase the diagnostic accuracy and advance new potential endoscopic therapeutic options.

Areas covered: This paper describes the role of pulmonary endoscopy, in particular ultrasound in the diagnosis and staging of lung malignancy. We will explore the recent expansion of ultrasound to include endoscopic ultrasound - bronchoscopy (EUS-B) and combined ultrasound (CUS) techniques. We will discuss in detail the advances in the workup of the peripheral pulmonary nodule.We performed a non-systematic, narrative review of the literature to summarize the evidence regarding the indications, diagnostic yield, and safety of current bronchoscopic sampling techniques.

Expert opinion: EBUS/EUS-B has revolutionized the diagnosis and staging of thoracic malignancy resulting in more accurate assessment of the mediastinum compared to mediastinoscopy alone, thus reducing the rate of futile thoracotomies. Although major advances in the assessment of the peripheral pulmonary nodule have been made, the role of endoscopy in this area requires further clarification and investigation.

Introduction: Tuberculosis (TB), an infective air-borne disease with worldwide non-homogeneous distribution, remains a top cause of morbidity and mortality. TB control is linked to early diagnosis and proper treatment of contagious TB cases and infected subjects at high risk of developing TB.

Areas covered: A narrative review of pulmonary TB in non-HIV adults with reference to high-income countries. Modern medicine offers several advancements in diagnostics and therapeutics of TB, but they often remain to be extensively implemented in real life. In high-income countries TB is now relatively uncommon, but it remains a health and socio-economic burden that should not be underestimated.

Expert opinion: Pulmonologists should maintain expertise toward TB for several reasons. First, the lung is the most common and the infectious moiety of TB. Second, TB remains a global issue due to common travels of western people and migrations from areas with high incidence of TB. Third, as TB has heterogenous clinics, its prompt diagnosis may be difficult. Fourth, TB is a curable disease, but its management is complex and predisposes to poor adherence with failures/relapses and selection of drug-resistant strains.

Introduction: Excessive mucus secretion is pivotal in chronic obstructive pulmonary disease (COPD) pathophysiology, particularly in chronic bronchitis phenotypes. Cystic fibrosis transmembrane conductance regulator (CFTR) has been implicated in COPD-related hypersecretion with acquired dysfunction, and emerged as a therapeutic target. However, the clinical efficacy of CFTR-potentiators in COPD remains controversial.

Methods: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal (CSTJ), and Wanfang Database to retrieve eligible studies published before 28 May 2024.

Results: A total of 1172 COPD patients were included, meta-analysis showed that CFTR-potentiators significantly increased forced expiratory volume in 1 s (FEV₁) and decreased sweat chloride and fibrinogen levels, with moderate-to-high quality evidence. However, no significant effects were observed on the percentage of detected FEV₁ to predicted FEV₁ (FEV₁% predicted), forced vital capacity (FVC), COPD assessment test (CAT) score, St. George's Respiratory Questionnaire (SGRQ) score, or acute exacerbation times, with low-to-moderate quality evidence.

Conclusion: Our meta-analysis demonstrated CFTR-potentiators' potential efficacy in increasing FEV₁, decreasing sweat chloride and fibrinogen levels, despite limited impacts on FEV₁% predicted, FVC, CAT score, SGRQ score, and acute exacerbations, underscoring the necessity for future research to evaluate its effects on mucus hypersecretion, acute exacerbations, hospitalizations, and mortality in COPD management. Review registration PROSPERO Identifier: CRD42024538708.

Introduction: The Global Lung Function Initiative (GLI 2012) has published multiethnic spirometry reference values. To identify studies that evaluated the compatibility (applicability, validity, representativeness, agreement and/or adequacy) of the reference equations proposed by the GLI 2012 for spirometry tests in different populations.

Methods: Systematic searches were carried out on the PubMed, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science and Google Scholar databases. Cross-sectional observational studies published between 2012 and 2013 onwards that evaluated the compatibility of the GLI 2012 in children, adolescents and young adults (3-20 years old) were included. The references were manually searched and the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Analytical Studies was applied to assess the methodological quality of the studies included.

Results: All of the 5632 studies identified were classified as low risk of bias, but only 21 were deemed eligible for inclusion. Of these, 8 reported satisfactory GLI 2012 compatibility for their populations (Argentina, Spain, Columbia, Djibouti, Norway, Poland, Jordan and Zimbabwe), 5 cautious applicability, and the remaining 8 considered the equation unsatisfactory, since it over or underestimated spirometric parameters.

Conclusion: The GLI 2012 equations are not applicable to all populations and must be tested before being adopted.

Introduction: Obstructive airway diseases asthma and COPD represent a significant healthcare burden. Airway hyperresponsiveness (AHR), a salient feature of these two diseases, remains the main therapeutic target. Airway smooth muscle (ASM) cell is pivotal for bronchomotor tone and development of AHR in airway diseases. The contractile and relaxation processes in ASM cells maintain a homeostatic bronchomotor tone. It is critical to understand the molecular mechanisms that disrupt the homeostasis to identify novel therapeutic strategies for AHR.

Areas covered: Based on review of literature and published findings from our laboratory, we describe intrinsic and extrinsic factors - disease phenotype, toxicants, inflammatory/remodeling mediators- that amplify excitation-contraction (E-C) coupling and ASM shortening and or diminish relaxation to alter bronchomotor homeostasis. We posit that an understanding of the ASM mechanisms involved in bronchomotor tone imbalance will provide platforms to develop novel therapeutic approaches to treat AHR in asthma and COPD.

Expert opinion: Contractile and relaxation processes in ASM cell are modulated by intrinsic and extrinsic factors to elicit bronchomotor tone imbalance. Innovative experimental approaches will serve as essential tools for elucidating the imbalance mechanisms and to identify novel therapeutic targets for AHR.

Introduction: The experiences and needs of living with chronic respiratory diseases (CRD) can be overwhelming. Individuals often rely on informal care for daily assistance and having a family/friend caregiver has been associated with better health outcomes. Nevertheless, family/friend caregivers frequently feel alone and unsupported. Pulmonary rehabilitation (PR) leads to multidimensional benefits across CRD and individuals have suggested improvements for PR. Family/friend caregivers highly support PR in practical and psychosocial ways and have identified this intervention as an opportunity to be supported. This reciprocal relationship between PR and the family/friend caregivers has been scarcely explored and its importance for the management of CRD is poorly understood.

Areas covered: This perspective synthesizes the experiences and needs of living with CRD from the perspective of people with CRD and their family/friend caregivers; and proposes a vision of a reciprocal/symbiotic relationship, through PR, for optimizing care for people with CRD and their caregivers.

Expert opinion: A deeper understanding/recognition of the extensiveness and somewhat overlap of the experiences and unmet needs of individuals with CRD and their family/friend caregivers; and of the reciprocal/symbiotic relationship between PR and the family/friend caregivers might be important to optimizing management and, ultimately, individuals and caregivers' outcomes in CRD.

Background: Compare the changes and differences in metabolome and lipidome profiles among severe COVID-19 and CAP patients with ARF to identify biomarkers that could be used for personalized diagnosis, prognosis, and treatment.

Research design and methods: Plasma samples were taken at hospital admission (baseline) and on the 5^th day of hospitalization (follow-up) and examined by RP-LC-QTOF-MS and HILIC-LC-QTOF-MS.

Results: 127 patients, 17 with CAP and 110 with COVID-19, were included. The analysis revealed 87 altered metabolites, suggesting changes in the metabolism of arachidonic acid, glycerolipids, glycerophospholipids, linoleic acid, pyruvate, glycolysis, among others. Most of these metabolites are involved in inflammatory, hypoxic, and thrombotic processes. At baseline, the greatest differences were found in phosphatidylcholine (PC) 31:4 (p < 0.001), phosphoserine (PS) 34:3 (p < 0.001), and phosphatidylcholine (PC) 36:5 (p < 0.001), all of which were notably decreased in COVID-19 patients. At follow-up, the most dysregulated metabolites were monomethyl-phosphatidylethanolamine (PE-Nme) 40:5 (p < 0.001) and phosphatidylcholine (PC) 38:4 (p < 0.001).

Conclusions: Metabolic and lipidic alterations suggest inhibition of innate anti-inflammatory and anti-thrombotic mechanisms in COVID-19 patients, which might lead to increased viral proliferation, uncontrolled inflammation, and thrombi formation. Results provide novel targets for predictive biomarkers against CAP and COVID-19.

Trial registration: Not applicable.