Expert review of respiratory medicine最新文献

Introduction: Asthma still represents a crucial public health challenge with significant health consequences. The study aims to estimate the prevalence of physician-diagnosed self-reported asthma in Greece and to unravel comorbid conditions and risk factors.

Research design and methods: The HYDRIA survey was the first national project on the health of the population in Greece. Data regarding demographic, lifestyle characteristics, and medical history were recorded through personal interviews from June 2013 to December 2014. Weighting factors were applied to ensure national representativeness of results.

Results: The study includes 4011 men and women. The estimated prevalence of self-reported physician-diagnosed asthma was 8.6% (95% CI: 7.5-9.8%). The most frequent comorbidity was allergic rhinitis, reaching a prevalence of 47.3%. Individuals with asthma reported a significantly higher percentage of perceived restrictions in daily activities (p-value < 0.001). They presented double the risk of having restrictions [2.04 (95% CI: 1.52-2.74); p-value < 0.001]. Age and atopy were significant predictors, however, an interaction indicated that the effect of atopy decreases with age (p for interaction = 0.037).

Conclusions: The estimated prevalence of self-reported physician-diagnosed asthma in Greece is 8.6%. Atopy, especially in young age, and age represent risk factors for asthma. Patients with asthma experience double the risk of having restrictions on daily activities compared to individuals without asthma.

Introduction: To ascertain the frequency of obstructive ventilatory impairment (OVI) among children/adolescents referred for spirometry, using definitions provided by various international respiratory societies.

Methods: This cross-sectional, bi-centric study included 602 children/adolescents aged 6 to 18 years. Subjects completed a medical questionnaire, and clinical and anthropometric data were collected. Spirometric measurements were performed using two spirometers. OVI was assessed using five definitions: i) 2023-Global Initiative for Asthma (GINA): FEV₁ < 80% and FEV₁/FVC ≤ 0.90; ii) Irish College of General Practitioners (ICGP): FEV₁/FVC < 0.70; iii) European Respiratory Society and American Thoracic Society (ERS-ATS): FEV₁/FVC z-score < -1.645; iv) National Institute for Health and Care Excellence (NICE): FEV₁/FVC < 0.70 or FEV₁/FVC z-score < -1.645; and v) Canadian Thoracic Society (CTS): FEV₁/FVC < 0.80 or a FEV₁/FVC z-score < -1.645.

Results: The frequency of OVI varied significantly (Chi-square test < 0.001) depending on the definition applied: ICGP (7.6%), ERS-ATS or NICE (19.3%), 2023-GINA (24.9%), and CTS (27.9%). This indicated that the definitions are not equivalent in identifying OVI.

Conclusion: The rate of OVI in pediatric populations varies considerably based on the diagnostic criteria used. Clinicians and researchers should therefore interpret prevalence data cautiously and always specify which definition was applied.

Introduction: Pneumonia is a major cause of death and disability worldwide. A host of pathogens causes pneumonia, and pneumonia presents with a remarkable heterogeneity of clinical symptoms and signs and has varied outcomes. Current approaches to pneumonia diagnosis and risk stratification lack precision such that there is no universally agreed upon biomarker or scoring system. These limitations have prompted calls for novel, noninvasive, and more precise approaches to better diagnosing pneumonia and predicting outcomes.

Areas covered: We performed a comprehensive literature search through PubMed to identify studies reporting on breath biomarkers in pneumonia published up to 31 July 2025. This manuscript explores breath-based metabolomics as a novel approach to biomarker development in pneumonia. It describes breath collection methods, including devices available and types of breath samples for analysis. It reviews the potential role of exhaled breath analysis to expedite pneumonia diagnosis, monitor response to therapy, and predict clinical trajectory.

Expert opinion: Breath-based metabolomics could improve the recognition and management of pneumonia. It is a noninvasive, potentially continuous method that provides a direct window into the lung for novel insights into the underlying biology of pneumonia.

Introduction: A small fraction of the estimated 25,000-30000 children (<15 years) who develop multidrug-resistant (MDR) tuberculosis (TB) globally every year are diagnosed and started on appropriate treatment. However, recent years have brought rapid changes to diagnostics, prevention, and treatment strategies.

Areas covered: We present current data on pediatric and adolescent MDR-TB combined with expert opinion to guide the reader through the pediatric and adolescent MDR-TB care cascade. This includes background information and practical guidance on the disease, the epidemiology, diagnostics, treatment options, and post MDR-TB sequalae. We also address the special circumstances of adolescents, comorbidities, and the socioeconomic impact of MDR-TB. PubMed was searched for suitable articles and national and international guidelines were reviewed.

Expert opinion: The roll-out of low complexity molecular diagnostics and advanced techniques, such as targeted next-generation sequencing, have the potential to rapidly diagnose children and adolescents with MDR-TB. The recently introduced short-all oral regimens provide safer and shorter treatment options. The effectiveness of levofloxacin as MDR-TB preventive treatment has been demonstrated. However, wide implementation of such new and advanced tools is still pending and improvements in diagnostics are crucial to increasing the proportion of children and adolescents with MDR-TB being diagnosed.

Introduction: Rheumatoid Arthritis (RA) and Chronic Obstructive Pulmonary Disease (COPD) are chronic, progressive inflammatory conditions that may coexist, contributing to greater morbidity and complexity in clinical management. The overlap between these two conditions remains under-recognized despite growing evidence of shared pathogenic mechanisms and risk factors.

Areas covered: This review explores the emerging evidence linking RA and COPD, focusing on shared inflammatory pathways, genetic susceptibility, and environmental influences such as smoking and air pollution. A comprehensive literature search was conducted using PubMed and Scopus databases with keywords including 'rheumatoid arthritis,' 'COPD,' 'pulmonary involvement,' and 'inflammatory overlap.' Key findings highlight diagnostic challenges stemming from symptom overlap, the underdiagnosis of COPD in RA patients, and the clinical impact of dual disease burden. The review also discusses the importance of multidisciplinary collaboration, optimal use of spirometry, imaging, and symptom-based questionnaires as screening tools, and strategies for balancing immunosuppressive therapy with respiratory health.

Expert opinion: Greater awareness of COPD as a pulmonary manifestation of RA is essential. Early recognition through systematic screening and integrated care models may significantly improve patient outcomes and reduce disease burden.

Introduction: Ventilator-associated pneumonia (VAP) is a deadly hospital-acquired infection that can impact between 5% and 40% of patients receiving mechanical ventilation. While preventative measures such as prophylactic antibiotics and oral care provided by the nursing staff exist, they are often insufficient and carry their own set of challenges. As a result, VAP not only increases hospital length of stay and rates of mortality but can also put a significant financial burden on hospitals and care centers.

Areas covered: This article provides an overview of current measures and ideas in development for VAP prevention, as well as their challenges and downfalls. The use of light therapies in combating infection are also discussed, with a particular emphasis on antimicrobial blue light as a potential tool for dealing with VAP. A comprehensive literature search and narrative review was conducted using the PubMed database through June 2025.

Expert opinion: Novel applications of blue light in VAP prevention may significantly improve patient outcomes. This technology may also help reduce rates of clinician burnout. This reduction is especially important in low- and middle-income countries where access to advanced resources may be limited. Thus, the authors urge development in this field as the need for infection-prevention technologies grows yearly.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a multifactorial respiratory disorder influenced by genetic, environmental, and lifestyle factors such as smoking. The Transforming Growth Factor Beta Receptor 1 (TGFBR1) plays a crucial role in regulating cell proliferation, differentiation, apoptosis, and immune modulation. Dysregulation of TGFBR1 may disrupt downstream signalling, leading to chronic inflammation, extracellular matrix accumulation in COPD. The present study aimed to evaluate the association of TGFBR1 gene variants rs7040869 (G>A), rs6478974 (A>T), rs4743325 (G>T), and rs597457 (C>A) with COPD susceptibility in a North Indian population.

Methods: This study comprises 500 COPD cases and 500 controls. Genotyping of the selected single-nucleotide polymorphisms (SNPs) was performed, and statistical analyses, including logistic regression, haplotype analysis, Classification and Regression Tree (CART), and Multifactor Dimensionality Reduction (MDR), were applied to assess gene-disease associations.

Results: The rs6478974 variant showed significant protective association with COPD, persisting after Bonferroni correction. Combined genotype analysis indicated that GA+GT genotypes of rs7040869 and rs4743325 increased disease risk, while CART identified rs6478974 and rs597457 as key interaction nodes.

Conclusion: This study is the first in a North Indian cohort to identify the protective role of rs6478974 in COPD, emphasising the significance of TGFBR1 polymorphisms in disease pathogenesis and risk prediction.

Introduction: Isolated lung perfusion (ILP) is a platform equipped for localized delivery, assessment, and optimization of lung-targeted therapies to manage acute respiratory distress syndrome (ARDS), acute lung injury, and transplantation. Here we review platform capabilities, therapeutic potential, and translational pathways with particular focus on ARDS.

Areas covered: A systematic search was performed in the PubMed database to identify relevant works. From this comprehensive review, we discuss the historical application of ILP in lung transplantation and thoracic oncology, and its progression to treating acute lung injury. Recent preclinical studies have demonstrated the efficacy of pharmacological interventions, gene therapy, and cell-based approaches delivered via ILP. Molecular investigations have revealed mechanisms underlying ILP effects, including modulation of inflammatory pathways, enhancement of cellular repair processes, and activation of tissue protection mechanisms. Significant technical refinements have extended perfusion durations, improved monitoring capabilities, and enhanced delivery systems.

Expert opinion: ILP has surfaced as the ideal platform for precision medicine approaches to ARDS management. Despite significant advances, challenges to clinical translation persist. Issues of standardization, cost analysis, and minimally invasive techniques need to be addressed to continue expanding in diagnostic utility and therapeutic benefit with a focus on personalized approaches based on ARDS etiology and patient-specific biomarkers.

Introduction: Acute respiratory distress syndrome (ARDS) is a life-threatening syndrome characterized by diffuse alveolar damage, severe hypoxemia, and dysregulated inflammation. Despite improvements in lung-protective ventilation and supportive care, mortality remains high, highlighting the need for therapies targeting core mechanisms of injury and repair. Mesenchymal stromal cells (MSCs) have demonstrated therapeutic potential largely via paracrine mechanisms, with extracellular vesicles (EVs) emerging as a cell-free alternative that retains key MSC benefits while overcoming limitations related to cell viability, engraftment, and scalability.

Areas covered: This review synthesizes current evidence on MSC-derived EVs (MSC-EVs) in ARDS, encompassing mechanisms of action, preclinical efficacy, delivery strategies, and translational challenges. Studies published from 2015 to 2025 were retrieved from PubMed, Web of Science, and ClinicalTrials.gov. Emphasis is placed on immunomodulatory effects, restoration of alveolar - capillary barrier integrity, and transfer of functional proteins, mRNAs, and microRNAs.

Expert opinion: MSC-EVs represent a promising, disease-modifying therapy with potential to reduce ventilation duration, extracorporeal support, and overall healthcare burden. Key challenges remain, including standardized manufacturing, validated potency assays, and identification of patient selection biomarkers. Integration of bioengineering innovations, GMP-compliant production pipelines, and stratified clinical trial designs will be critical to accelerate translation and enable definitive evaluation in late-phase studies.

Introduction: Pediatric and neonatal acute respiratory distress syndrome (PARDS/NARDS) cause significant mortality or long-term morbidity in childhood. The optimal management remains elusive, making a review of therapies like inhaled nitric oxide (iNO) timely and crucial.

Areas covered: This review elucidates the mechanisms of iNO and critically appraises its application in PARDS/NARDS. A literature search covering the period up to December 2024 was conducted in PubMed, Embase, and Web of Science. We evaluated its effects on oxygenation, inflammation, and outcomes, highlighting the inconclusive impact on survival and neurodevelopment, and the limitations posed by variable response and safety concerns.

Expert opinion: While iNO can improve oxygenation, its routine use is not recommended due to uncertain long-term benefits. Future, rigorous trials must identify predictive biomarkers and patient subgroups most likely to benefit, paving the way for personalized iNO therapy in neonatal and pediatric critical care.