Expert review of respiratory medicine最新文献

Introduction: Overgrowth and colonization by non-typeable Haemophilus influenzae (NTHi) is a common feature of increasing disease severity, treatment resistance and increased susceptibility to disease exacerbations across chronic airways diseases (CADs). Whether NTHi is a driver of respiratory disease or reflects that the damaged airway has become a permissive environment for growth remains to be proven.

Areas covered: In this review, we discuss the potential roles of hypermutation, biofilm formation and intracellular living in allowing NTHi to adapt to living in the lungs of individuals with CADs. Furthermore, we also highlight immunological, structural and mucosal changes in the lungs themselves that can create a permissive niche for NTHi colonization. Given the significance of the host-pathogen interaction in the pathophysiology of CADs, we also consider which host and bacterial mechanisms may serve as potential targets for novel therapeutics. To achieve this we performed a comprehensive literature search through PubMed to identify studies reporting on NTHi in chronic airways diseases published up to 1 December 2025.

Expert opinion: A deeper understanding of the dynamic interactions between NTHi and the diseased airway may help identify novel diagnostic and therapeutic interventions that can be effective across multiple CADs.

Background: Idiopathic pulmonary fibrosis (IPF) significantly increases lung cancer risk, with cumulative incidence exceeding 50% at 10 years. We evaluated whether antifibrotic therapies provide cancer-protective effects beyond their established antifibrotic actions.

Methods: We conducted a systematic review searching MEDLINE, EMBASE, and Cochrane databases through July 2025 per PRISMA guidelines. Observational studies comparing lung cancer incidence in IPF patients receiving antifibrotics (pirfenidone or nintedanib) versus untreated controls were included. Random-effects meta-analysis with sequential sensitivity analyses was performed.

Results: Four observational studies with 15,582 participants were included. Primary pooled risk ratio was 0.39 (95% CI: 0.13-1.14; I² = 98%). Sequential sensitivity analyses addressing confounding by indication and biological heterogeneity demonstrated statistically significant risk reductions: 73% (RR 0.27; 95% CI: 0.16-0.48; I² = 44%) and 76% (RR 0.24; 95% CI: 0.08-0.69; I² = 67%) in pirfenidone-specific analyses.

Conclusions: Pirfenidone specifically may reduce lung cancer risk in IPF patients by 73-76%, though evidence is limited by observational designs, geographic restriction to East Asian populations, and biological heterogeneity between mechanistically distinct antifibrotic agents. Insufficient data exist for nintedanib. Agent-specific prospective randomized controlled trials are warranted. Protocol registration: PROSPERO identifier CRD420251119104.

Introduction: Severe asthma (SA) is a heterogenous disease with multiple clinical phenotypes. 'Early atopic asthma' is the predominant phenotype in children with SA. This phenotype is also identified in adults with SA. However, the role of immunoglobulin E (IgE)-mediated allergy in SA is still under debate.

Areas covered: This review summarizes current evidence linking IgE-mediated sensitization to SA. Electronic search was realized in Medline and PubMed databases by using the following terms: 'severe asthma,' 'IgE-mediated' associated with 'environmental allergens,' 'aeroallergens,' 'house dust mites,' 'pollens,' 'pets,' 'moulds,' 'cockroach,' 'food allergy,' 'drug allergy,' 'venom allergy,' 'atopic dermatitis,' 'eczema,' 'anaphylaxis.' Exposure to most aeroallergens of SA patients with atopy is associated with an increased risk of severe exacerbations. Children with food allergy have more severe asthma, poor symptoms control, and a high hospitalization rate. More limited evidence exists for the other IgE-mediated conditions and SA.

Expert opinion: IgE-mediated pathways play central role in the pathogenesis of various allergic diseases, including asthma. However, the allergic burden seems to be more important in children with SA than in adults. Future research may provide a better understanding of the role of IgE-mediated allergy in SA and coexisting allergic diseases with improvement in their clinical outcomes.

Introduction: T2-comorbidities are the most common in severe asthma (SA) patients and have a negative impact on disease outcomes but also an important socio-economic burden. Treating SA and its comorbidities by one medication is a very exciting possibility for the clinicians. Several biologics used for SA showed benefits on T2-comorbidities, but currently more limited data exists for tezepelumab, most recently developed in this domain.

Areas covered: This paper summarizes the available evidence regarding the efficacy of tezepelumab on T2-comorbidities of SA. Electronic search queries were applied to PubMed and Medline databases by using the following terms: 'tezepelumab,' 'severe asthma,' 'allergic rhinitis' (AR), 'chronic rhinosinusitis,' 'nasal polyps' (CRSwNP), 'aspirin exacerbated disease (AERD),' 'atopic dermatitis' (AD), 'eczema,' 'chronique spontaneous urticaria' (CSU),'food allergy' (FA), 'eosinophilic esophagitis' (EE).

Expert opinion: Tezepelumab treatment showed undeniable benefits on CRSwNP and AERD by improving sino-nasal and asthma outcomes. If the efficacy of tezepelumab on severe allergic asthma is well documented, current data are insufficient to conclude on its impact on AR. The effects of tezepelumab on AD and CSU were disappointing. No consistent data exists regarding FA and EE. Future studies are needed to confirm the efficacy of tezepelumab on AR, FA, and EE.

Objective: The aim of this study is to assess the effectiveness of an Internet-based comprehensive nursing intervention in improving lung function, treatment adherence, and quality of life in COPD patients.

Methods: A total of 104 COPD patients admitted to our hospital between October 2023 and January 2024 were randomly assigned to either a control group (n = 52) or an experimental group (n = 52). The control group received routine nursing interventions, including general education and routine care. The experimental group received Internet-based comprehensive nursing, which included personalized action plans, telehealth consultations, health education, dietary guidance, and psychological support delivered via the WeChat platform.

Results: The experimental group demonstrated significantly higher compliance (92.3%) compared to the control group (76.9%, p = 0.034). The improvement in PaO₂ and PaCO₂ levels, as well as lung function indicators (FEV₁, FVC, and FEV₁/FVC ratio), was significantly greater in the experimental group (p < 0.001). Moreover, the experimental group experienced a more substantial reduction in SGRQ scores (p < 0.001), indicating improved quality of life. Notably, a strong correlation between increased compliance and better clinical outcomes was observed (p < 0.001).

Conclusions: The application of Internet-based comprehensive nursing interventions significantly enhances treatment adherence, lung function, and quality of life in COPD patients.

Introduction: Severe therapy-resistant pediatric asthma (STRA) is an uncommon but high-impact form of childhood asthma, affecting 2-5% of patients yet causing disproportionate morbidity, healthcare use, and corticosteroid exposure. It is defined by uncontrolled disease despite optimized high-dose inhaled corticosteroids plus additional controllers, after exclusion and correction of modifiable factors. Accurate distinction from difficult-to-treat asthma is essential to avoid unnecessary treatment escalation and enable timely advanced interventions.

Areas covered: This narrative review summarizes current knowledge on STRA pathophysiology, diagnosis, and management in children, with a focus on precision medicine. Mechanistic insights include epithelial barrier dysfunction, distinct inflammatory endotypes, early airway remodeling, and microbial - immune interactions. Biomarker-guided endotyping supports individualized care. The article evaluates the efficacy, safety, and positioning of approved biologics, while noting gaps in treating non-T2 phenotypes and in predicting biologic response.

Expert opinion: STRA management is shifting from empirical escalation to endotype-driven strategies. Biologics benefit biomarker-selected patients by reducing exacerbations, improving lung function, and lowering steroid dependence, sometimes addressing comorbid allergies. Future priorities include expanding options for non-T2 and mixed phenotypes, validating predictive biomarkers, integrating digital monitoring, and reducing global inequities in access to advanced therapy.

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.

Introduction: Dupilumab is a monoclonal antibody which selectively targets T2 inflammation by binding the IL-4 and 13 receptor and blocking its contribution to the immune activation. Clinical trials and real-life studies on severe asthma and nasal polyps patients have reported blood eosinophils fluctuation over the treatment course.

Areas covered: In the present narrative review the authors aim to provide a practical perspective on the recent evidence related to hypereosinophilia occurring during dupilumab therapy in respiratory indications, its underlying mechanisms, frequency, and clinical relevance, and to critically revise the currently proposed approaches to its management. Eosinophils increase is in most cases transient, spontaneously resolving, without any clinical relevance and no impact on efficacy. In fact, dupilumab safety profile is overall comparable with the other monoclonal antibody of the same drug class.

Expert opinion: Blood eosinophil count itself should not preclude dupilumab prescription, neither lead to dupilumab discontinuation, especially in the presence of ascertained drug efficacy and in the absence of signs suggesting a eosinophils-related complication. However, an extensive diagnostic work-up and regular follow-up monitoring is indicated, especially in patients with increased baseline eosinophils and coexisting nasal polyps and asthma.

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.