Expert review of respiratory medicine最新文献

Introduction: Chronic obstructive pulmonary disease (COPD) represents a significant global health burden. This review addresses the critical need for early identification and intervention by investigating the current research landscape in the early stages of the disease.

Areas covered: This review synthesizes the literature on the definitions, epidemiology, diagnostic approaches, prognosis, and management strategies for early COPD states, including preserved ratio impaired spirometry (PRISm), pre-COPD, young COPD, and mild COPD. A comprehensive literature search was conducted in PubMed and Web of Science up to October 2024.

Expert opinion: Experts believe that while conceptualizing early COPD offers transformative potential, progress is hampered by ambiguous diagnostic criteria and limitations in biomarkers. Future efforts should prioritize precision prevention through deep phenotyping and technological integration, acknowledging the risk of disparities.

Introduction: Asthma and fertility represent two health-related challenges for women of reproductive age. Women with asthma experience prolonged time of pregnancy and an increased likelihood of requiring fertility treatment.

Areas covered: While evidence on the association between asthma and pregnancy loss is conflicting, pregnancy itself is associated with additional risks of maternal and fetal complications. However, well-controlled asthma reduces these risks, underscoring the critical importance of proper management according to generally accepted asthma treatment guidelines. Age influences not only fertility but also the control of asthma during pregnancy, and increasing age correlates with a higher likelihood of uncontrolled asthma and exacerbations during pregnancy. Although systemic corticosteroid exposure during the first trimester may be associated with risks, the consequences of uncontrolled asthma and hypoxemia pose greater threats to fetal well-being and should therefore be administered according to guidelines if required.

Expert opinion: This review explores the relationship between asthma, fertility, and pregnancy outcomes, emphasizing the importance of asthma control and medication adherence. Practical recommendations are provided for women with asthma planning pregnancy, along with proposed future research directions to improve understanding and care in this population. In conclusion, women with asthma should be encouraged to plan pregnancies earlier in life, given the impact of age on fertility and asthma-related risks. While some may experience pregnancy loss, asthma does not reduce overall offspring numbers. Effective asthma management is essential to ensuring the health and well-being of both mother and fetus.

Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms causing persistent, often progressive airflow obstruction. Strength training is a therapeutic option to prevent and/or reverse muscle dysfunction in COPD patients. Objective: to analyze the literature on the effects of strength training in COPD patients.

Methods: A systematic review from the last ten years was conducted in August 2024 across PubMed, Scopus, WOS, Medline and CINAHL databases. The search included studies examining resistance training for upper and lower limbs. Methodological quality was analyzed using the PEDro scale and the RoB2 was used for risk of bias.

Results: Six randomized controlled trials were eligible for inclusion, obtaining an excellent or good methodological quality. Most repeated variables were exercise capacity, quality of life and muscle strength, finding statistically significant positive results in all of them.

Conclusions: Strength training appears to be safe and effective for COPD treatment, with improvements in exercise capacity, activities of daily living, muscle strength, lung function, quality of life and inflammatory levels. However, scientific evidence on this topic is scarce, and future high-quality, long-term studies are necessary to establish standardized protocols and assess the sustained benefits of strength training in COPD patients.Protocol registration: Identifier is CRD42024572717.

Introduction: Airway management is one of the most important interventions performed by paramedics in the prehospital setting. While the standard of care for over 40 years, multiple studies highlight pitfalls associated with prehospital airway management in adults. Considerably less research describes prehospital airway management in children.

Areas covered: We searched PubMed for articles from 2000 to present using the keywords 'children,' 'airway management,' 'intubation intratracheal,' 'Emergency Medical Services,' and 'paramedic.' Studies highlight the pitfalls of adult prehospital endotracheal intubation such as tube misplacement and dislodgement, multiple and failed insertion attempts, interruptions in chest compressions, and inadvertent hyperventilation. Multicenter clinical trials including the PART and Airways-2 trials support the use of newer supraglottic airways as potential alternatives to intubation in adults. Only limited data describe prehospital airway management in children, including only one clinical trial performed 25 years ago.

Expert opinion: New studies are needed to guide paramedic pediatric airway management practices. The Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) is an ongoing multicenter clinical trial that will provide critical new knowledge to guide prehospital pediatric airway management practices.

Introduction: To evaluate the efficacy and safety of Rituximab (RTX) in the treatment of pulmonary hypertension (PH) in patients with connective tissue diseases (CTDs).

Methods: A systematic review of the published literature was performed according to the PRISMA guidelines. Eligible articles were clinical trials, cohort studies, case series, and case reports of adult patients with CTD-PH treated with RTX. The selected languages were English and French.

Results: Six studies fulfilled the selection criteria and two of them were prospective. Most patients were from the U.S.A. and Russia. The predominant sex was female (85.9%), and the age of the included patients ranged from 29 years to 67 years. PH was confirmed by right heart catheterization in 3 studies. The CTDs associated with PH were systemic sclerosis (3 cases), adult-onset Still's disease (one case), systemic lupus erythematosus (one case) and mixed connective tissue disease (one case). The mean number of infusions was 4.2. The mean follow-up period across all studies was 18.3 months. Clinical and paraclinical parameters before and after RTX infusions were evaluated and showed improvement. RTX for the treatment of CTD-PH appeared to be well tolerated.

Conclusions: RTX seemed to be effective and safe in the treatment of CTD-PH.Systematic review registration: PROSPERO, ID: CRD420251037839.

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: PubMed was used for a literature search (1990-2025) on the minimally invasive surgical approaches for pneumothorax, which have evolved markedly, with video-assisted thoracic surgery (VATS) emerging as a preferred procedure. Systematic reviews of randomized control trials indicate that VATS is less invasive than traditional thoracotomy. Furthermore, uniportal VATS provides less postoperative pain and better cosmetic outcomes than thoracotomy. Currently, uniportal VATS seems preferred as the minimally invasive surgical approach for pneumothorax. New devices such as small-diameter thoracoscopes and forceps, which are used in uniportal subxiphoid VATS and uniportal subcostal robot-assisted thoracic surgery, may contribute to reducing the postoperative incidence of intercostal neuralgia and enhancing satisfaction with the cosmetic results.

Areas covered: The ideal surgical approaches for pneumothorax, referencing guidelines, and studies from various countries.

Expert opinion: This review explores various aspects of minimally invasive surgical approaches for pneumothorax. Uniportal VATS for pneumothorax via the intercostal approach is commonly performed worldwide and ensures high surgical quality. This review discusses what should be performed within the thoracic cavity to reduce the postoperative recurrence rate of pneumothorax, problems associated with thoracic adhesions that may be disadvantageous for pneumothorax patients in the future, and the latest surgical approaches that may become mainstream.

Background: Pleuroparenchymal fibroelastosis (PPFE) is an upper lobe - predominant interstitial pneumonia pattern that can be idiopathic or secondary and has unclear clinical characteristics, disease course, and prognostic factors. This study analyzed PPFE patient characteristics, identified mortality predictors, and compared disease progression between idiopathic and secondary PPFE.

Research design and methods: We retrospectively identified patients with PPFE and analyzed demographic, clinical, radiologic, and pathologic data. Linear regression mixed models were used to assess predictors of mortality and lung function decline.

Results: Among 81 patients identified, 73% were women, median age was 69.4 years, and 75% were nonsmokers. Idiopathic PPFE comprised 46% of cases; secondary PPFE was most commonly familial (40%) or autoimmune related (33%). Over a median follow-up of 777 days, 38% died; the 5-year survival rate was 53%. Mortality risk did not differ between idiopathic and secondary PPFE. Lower body mass index, lower forced vital capacity (FVC) at diagnosis, and smoking history predicted mortality. The decline in FVC was slower in idiopathic PPFE than secondary PPFE.

Conclusions: Idiopathic and secondary PPFE differ in FVC decline but not in mortality risk. Familial and autoimmune conditions are the most common secondary causes.

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder that arises in individuals with asthma or cystic fibrosis due to an exaggerated immune response to Aspergillus fumigatus. It leads to mucus plugging, recurrent exacerbations, and progressive bronchiectasis. Despite established diagnostic criteria, ABPA remains underdiagnosed, primarily due to its overlap with severe asthma and limited clinical awareness. Evolving insights into immunopathogenesis and the emergence of targeted therapies have begun to transform the management of ABPA.

Areas covered: We discuss the current evidence on immunopathogenesis, treatment, and monitoring of ABPA in asthma. The review covers established and emerging therapies, including systemic glucocorticoids, oral triazoles (such as itraconazole), inhaled antifungals, and biological agents. We provide practical guidance for initiating treatment based on disease phenotype and discuss treatment monitoring using clinical symptoms, serum biomarkers, chest imaging, and lung function tests.

Expert opinion: The management of ABPA is poised for a paradigm shift toward precision medicine. Future strategies will likely be driven by international registries, biomarker discovery using omics-based platforms, and the identification of endotype- and phenotype-specific treatments. Randomized trials comparing biologic therapies, combination approaches using antifungals and biologics, and the development of inhaled antifungal delivery systems are likely to reshape the management of ABPA.