Expert review of respiratory medicine最新文献

Introduction: Emergency departments (EDs) play a crucial role in managing exacerbation of COPD (ECOPD). However, there is currently no standardization of management criteria for ECOPD within the Spanish healthcare system. This document aims to outline the management of ECOPD in EDs in the context of 2025, serving as a guide for healthcare professionals working in emergency services.

Areas covered: Various aspects of the management of ECOPD in EDs are covered in this article, including severity classification, treatments (both pharmacological and nonpharmacological), criteria for hospital admission and discharge from the ED, treatment at discharge, palliative care, and management of frail patients.

Expert opinion: The authors, who are members of the Spanish Society of Emergency Medicine (SEMES), emphasize the importance of classifying the severity of the episode and the patient characteristics to tailor care to each individual. The authors also highlight the value of biomarkers, the appropriate use of ventilatory therapies for ECOPD patients, the importance of proper antibiotic management, and the establishment of clear referral protocols to prevent patients from feeling lost in the healthcare system. Finally, the need to personalize post-discharge treatments is underscored to enhance continuity of care and improve health outcomes.

Background: Obesity represents a frequent comorbidity in chronic obstructive pulmonary disease (COPD); however, its exact role as potential risk factor remains unclear. ur aim is to assess obesity's potential role for COPD development.

Research design and methods: The HYDRIA survey has been the first national project on the health of the population in Greece. Data regarding individual characteristics, lifestyle choices, medical history, dietary data and somatometric characteristics were recorded through personal interview in a representative sample of the population.

Results: Four thousand eleven men and women aged more than 18 years old were enrolled. COPD is more prevalent in obese people (10.1%; 95% CI: 6.0-14.2%) compared to 5.4%; 95% CI: 4.6-6.2% in non-obese participants. In multivariate analysis, obesity continues to be strongly associated with COPD (OR = 1.76 (95% CI: 1.23-2.53); p = 0.002). Age and smoking are also strong risk factors for COPD. The estimated prevalence of self-reported physician-diagnosed COPD in Greece is 5.9%.

Conclusions: Obesity may represent a potential unrevealed risk factor for COPD. Focus on obesity should be included in public health campaigns and preventive programs aiming to decrease the burden of disease and provide the necessary optimal management.

Introduction: Vitamin D deficiency is common in cystic fibrosis (CF) and may be linked to disease severity. We aimed to investigate the association between vitamin D deficiency and severity in non-CF bronchiectasis.

Methods: A systematic search of PubMed and Scopus (up to December 2024) identified relevant studies. After screening 170 articles, seven met the inclusion criteria. Study quality was assessed using NIH tools.

Results: Patients with non-CF bronchiectasis had significantly lower serum 25-hydroxyvitamin D (25OHD) levels compared to healthy controls. In one study, median 25OHD was 24.7 nmol/L in patients vs. 45.3 nmol/L in controls. Another reported mean levels of 14.7 ± 9.6 ng/mL vs. 19.8 ± 6.9 ng/mL, respectively. Disease severity was assessed using validated and semi-structured measures, including the bronchiectasis severity index (BSI), number of exacerbations, pulmonary function tests (PFTs), radiological scores (Bhalla, modified Reiff), and health-related quality-of-life (HRQL) tools. Most studies reported worse severity outcomes in vitamin D-deficient patients.

Conclusions: Although vitamin D deficiency appears to be associated with more severe non-CF bronchiectasis, heterogeneity between studies limits definitive conclusions. Future studies should incorporate standardized tools such as the eFACED score to better characterize disease severity.

Introduction: To evaluate the efficacy and safety of sotatercept, an activin signaling inhibitor, in pulmonary arterial hypertension (PAH).

Methods: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing sotatercept versus placebo in PAH. We calculated pooled risk ratios (RR) and mean differences (MD) with their 95% confidence intervals (CI) using a random-effects model. Heterogeneity was assessed with I² statistics. The GRADE approach was used to assess the certainty of evidence.

Results: Three RCTs comprising 601 patients were included. Compared to placebo, sotatercept significantly improved 6-minute walk distance (MD 40.57 m; 95% CI 26.64 to 54.5; p < 0.01), and WHO functional class (RR 2.04; 95% CI 1.53 to 2.7; p < 0.01). Sotatercept reduced pulmonary vascular resistance (MD -233.18 dyn·sec·cm^-5; 95% CI -295.84 to -170.52; p < 0.01) and pulmonary artery pressure (MD -14.94 mmHg; 95% CI -19.62 to -10.27; p < 0.01) at study end. No significant differences were observed in all-cause mortality or NT-proBNP levels. Sotatercept was associated with epistaxis, increased hemoglobin, and telangiectasia adverse events.

Conclusions: Sotatercept improves exercise capacity, WHO functional class and pulmonary hemodynamics in PAH, with an acceptable safety profile. Long-term studies are needed to confirm sustained benefits.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD420251032174.

Introduction: Extracorporeal membrane oxygenation (ECMO) remains a mainstay for refractory respiratory failure in select pediatric patients. Clinical practice surrounding its use continues to evolve, reflecting advances in technology, management strategies, and patient selection. Ongoing research and innovation are actively shaping VV-ECMO's future directions aimed at optimizing outcomes and increasing understanding of best practices.

Areas covered: This review summarizes the fundamental concepts of VV-ECMO and highlights established practices and ongoing questions with a focus on indications/contraindications, cannulation, ventilator management, anticoagulation, fluid management, and weaning/decannulation. We also examine recent advancements and emerging technologies that are shaping the evolution of pediatric ECMO therapy. Narrative literature review of the PubMed central database was utilized to help inform this review.

Expert opinion: Despite recent progress in pediatric VV-ECMO, substantial gaps remain in understanding optimal practices. And while there are many promising advances, there is a need for high-quality, collaborative research to further define best practices and guide ongoing future improvements for this life-sustaining therapy.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease characterized by relentless parenchymal scarring, deteriorating pulmonary function, and unpredictable exacerbations. The prognosis remains poor, despite antifibrotic and other therapies. Patients with IPF experience a high symptom burden, frequent hospitalizations, and uncertainty regarding disease progression. Advance care planning (ACP), the process of defining patients' preferences for medical care, is inconsistently implemented in IPF care. This often leads to end-of-life care unaligned with the patient's wishes and increased distress amongst patients and their care partners.

Areas covered: In this perspective, we argue for the early and routine integration of ACP into IPF management. We review the multifaceted patient-, provider-, and system-level barriers to ACP and propose actionable strategies to normalize, document, and operationalize patient-centered ACP across the IPF disease trajectory. We highlight the critical need for an interdisciplinary team to best address ACP.

Expert opinion: While IPF research has resulted in huge progress in the understanding of disease pathobiology and the expansion of treatment options, perhaps the most patient-centered portion of care remains under-studied. We must prioritize research to better understand an interdisciplinary system of iterative ACP that gives IPF patients a clear voice until the last moment of life.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a debilitating condition marked by persistent airflow limitation, leading to increased morbidity and mortality. Acute exacerbations of COPD (AECOPD) can cause rapid deterioration, resulting in hypercapnic respiratory failure and respiratory acidosis. Non-invasive ventilation (NIV) is a key treatment for AECOPD, improving gas exchange, oxygenation, and reducing work of breathing while avoiding the risks of invasive mechanical ventilation (IMV).

Areas covered: This review highlights NIV role as a first-line therapy in AECOPD management, discussing its mechanisms, indications, and clinical benefits. Proper patient selection, tailored settings, and careful monitoring are crucial for optimizing outcomes and minimizing complications.

Expert opinion: The widespread use of NIV in AECOPD management raises concerns about staff expertise, as success depends on patient selection, ventilator settings, and monitoring. Identifying failure predictors is crucial to prevent delayed intubation and poor outcomes. Research should focus on training, reducing errors, and advancing technology, including Artificial Intelligence-driven automation to improve synchrony. Despite its increased use, especially during COVID-19, progress in staff education and technology remains limited. Enhancing clinician confidence and developing intelligent ventilator algorithms are key, but human expertise remains essential in ensuring effective and life-saving NIV application.

Background: Accurate spirometry interpretation requires reference equations tailored to the target population. This study evaluated the performance and diagnostic agreement of the locally developed 2018 Jordanian equation and the Global Lung Initiative (GLI) global (2022), GLI-2012 Caucasian, and GLI-2012 Other/Mixed equations among healthy adult Jordanians.

Research design and methods: In this cross-sectional study, healthy nonsmoking Jordanian adults aged ≥ 18 years were recruited from various regions. Spirometry and anthropometric data were collected. Each equation's suitability was assessed using mean z-score deviations from zero and standard deviations from one (via t-tests and chi-square tests). Linear and quantile regressions examined relationships between anthropometrics and lung function. Diagnostic agreement was evaluated using Cohen's kappa and frequency of classification shifts.

Results: Among 799 participants (400 males), the Jordanian equation showed the best fit, with mean z-scores closest to zero and standard deviations near one. GLI global (2022) and GLI-2012 equations showed significant deviations (p < 0.001), mainly due to age-related bias. Agreement was highest between GLI global (2022) and GLI-2012 Other/Mixed; GLI-2012 Caucasian classified the fewest as normal.

Conclusion: The Jordanian equation provided better accuracy than GLI equations. Its use in practice may reduce misclassification and improve respiratory disease management, underscoring the value of population-specific standards.