Expert review of respiratory medicine最新文献

Introduction: Adequate airway humidification is important in respiratory care, significantly affecting patient comfort, airway function, and clinical outcomes. Adequate humidification helps prevent airway dryness, mucosal damage, and respiratory complications, making its understanding crucial for effective patient management.

Areas covered: The bibliographic database PubMed and search engine Google Scholar was searched for systematic reviews and metanalyses, clinical trials and observational studies on humidification practices in adult spontaneously breathing tracheostomized patients and those receiving invasive mechanical ventilation, noninvasive ventilation (acute and long term), and oxygen therapy (low and high flow). The physiological principles of airway humidification, the characteristics and applications of various active and passive humidification devices, impact of ventilator settings, interfaces, and patient-specific factors on humidification efficacy were reviewed.

Expert opinion: There is no doubt that humidification plays a crucial role in maintaining airway mucosal integrity. A comprehensive knowledge of humidification strategies is must for their proper implementation in clinical practice. Even when upper airways are intact, as in NIV or oxygen therapy, humidification may still be necessary to prevent discomfort and maintain mucosal integrity. Future research should focus on refining humidification strategies to maximize efficacy, minimize complications and developing improved methods for monitoring airway humidity at the patient interface.

Introduction: The implementation of non-invasive respiratory support (NIRS) in patients with acute respiratory failure has led to significant improvements in clinical outcomes.

Areas covered: In this article, we discuss the advances in NIRS focusing on how to improve the success rate of NIRS in acute hypoxemic respiratory failure, acute hypercapnic respiratory failure, and weaning. Moreover, the risk of patient self-inflicted lung injury is described and selection of the best NIRS treatment modality in each setting is indicated and justified.

Expert opinion: Effectiveness of NIRS is dependent on choosing the right ventilator and interface. Rotational use of interfaces is highly recommended to avoid pressure sores. The recent implemented innovations allow the optimization of the patient-ventilation interaction, demonstrating the evolving role of Nasal high flow therapy and Helmet NIRS.

Introduction: Acute exacerbations in interstitial lung diseases, especially idiopathic pulmonary fibrosis, remain a significant clinical challenge associated with high mortality. Previously used empirical immunosuppressive therapies, notably cyclophosphamide, have proven ineffective.

Areas covered: A literature search was conducted using the PubMed and ClinicalTrials.gov (NCT) databases for studies published up to March 2025. This review summarizes recent randomized clinical trial data on acute exacerbations, highlighting negative results for cyclophosphamide and recombinant thrombomodulin and positive preventive effects of antifibrotics such as nintedanib and pirfenidone. The evidence supporting vaccination strategies, methodological limitations in trial design, and diagnostic challenges are also discussed.

Expert opinion: Shifting clinical practice away from harmful therapies toward precision medicine approaches, utilizing biomarkers, preventive antifibrotic strategies, and novel therapeutic targets, is essential. International collaboration in clinical research is crucial to improve patient outcomes.

Background: Severe asthma is a chronic respiratory disease posing challenges for clinicians and patients, increasing health-care costs and patients' poor quality of life. Advances in precision medicine have introduced novel approaches to managing severe asthma, including breathomics, a promising field using exhaled breath analysis to identify disease biomarkers. Among these techniques, exhaled breath condensate (EBC) analysis has emerged as a potential noninvasive tool for monitoring airway inflammation and disease progression.

Methods: A systematic literature review was conducted to identify EBC biomarkers for monitoring severe asthma, searching across PubMed, Cochrane, Google Scholar, MEDLINE, ISRCTN, EMBASE and Web of Science.

Results: Twenty-three studies were included in the review. Key markers identified were 8-isoprostane, hydrogen peroxide (H₂O₂), nitric oxide (NO), and eicosanoids. Among these, 8-isoprostane was the most widely studied biomarker in severe asthma, while H₂O₂ seems to be most closely linked to assessing asthma control.

Conclusions: To the best of our knowledge, this is the first systematic review focusing on EBC biomarkers in severe asthma. Breath analysis represents a promising noninvasive approach to evaluate airway inflammation, identify early signs of poorly controlled asthma and monitor treatment response. Further research is needed to validate these biomarkers for clinical application.

Protocol registration: uk/prospero with identifier CRD42023406669 https://www.crd.york.ac.

Introduction: Chronic obstructive pulmonary disorder (COPD) is a significant health challenge in India, mainly attributed to smoking, air pollution, and biomass fuel exposure. Severe COPD is associated with frequent hospitalization due to recurring exacerbations, leading to increased healthcare utilization and economic burden, and a higher risk of cardiovascular events and mortality. Preventing exacerbations is key to slowing disease progression, as each exacerbation worsens lung function and increases the risk of future exacerbations. Evidence suggests that implementing evidence-based discharge care bundles may reduce hospital readmissions and improve patient outcomes. A virtual advisory board meeting involving 7 leading experts from pulmonary medicine and cardiology specialties was convened in June 2024 to gain insights into the current unmet needs in managing COPD exacerbations, particularly focused on discharge protocols.

Areas covered: Targeted, nonsystematic literature searches using MEDLINE databases focused on local or national discharge protocols/guidelines for COPD patients' post-exacerbation, their clinical implementation, and identified challenges and gaps encountered following hospital discharge.

Expert opinion: The panel proposed a standardized COPD discharge protocol based on local clinical practices for uniform implementation and uptake across all healthcare settings in India. Experts recommended prioritizing the accessible and affordable interventions including smoking cessation, education of patients and caregivers, medication reconciliation, and referral to home-based pulmonary rehabilitation programs.

Introduction: Notwithstanding considerable progress in asthma management, a significant proportion of patients continue to demonstrate suboptimal control. Research has identified small airways dysfunction (SAD) as a critical site for airflow limitation and an independent risk factor of exacerbations, with airway oscillometry (AO) playing a pivotal role in this field.

Areas covered: Spirometry is widely accepted as the gold standard for evaluating respiratory function. However, it is primarily sensitive to large airway obstruction… AO has emerged as a valuable tool for quantifying SAD, and recent studies have established strong correlations between AO, advanced imaging techniques and type 2 biomarkers. We conducted a review of the English-language literature from the beginning of the databases reviewed through June 2025.

Expert opinion: In recent years, a substantial body of literature has emerged, leading to a resurgence of interest in the role of AO in asthma management. It is recommended that AO be utilized as a primary diagnostic tool for the early detection of SAD, even when spirometric values are within normal limits. The identification of patients with asthma in accordance with the criteria of defined severe SAD-oscillometry signifies the culmination of the evolution of AO from a research tool to a clinical tool.

Introduction: Malignant pleural effusions (MPE) affect many patients with advanced malignant disease and lead to significant symptomatic burden. Management is primarily focused on controlling symptoms. IPCs are considered an alternative treatment strategy to chemical pleurodesis and in randomized clinical trials, are shown to have comparable outcomes with regards to symptom management such as dyspnea score and quality of life, and are associated with shorter length of hospital stay. Additional studies have examined the optimal drainage strategy for IPCs and the combination of IPC and pleurodesis. The most common complication is infection, and management differs based on the specific infection type. For many patients, IPCs are likely a cost-effective option for management of MPE compared to alternative approaches.

Areas covered: This review article details the role of the indwelling pleural catheter (IPC) for symptom control, strategies for management, removal, complications, cost-effectiveness, and future directions.

Expert opinion: There are various management options for MPE, each with their own advantages and disadvantages. Management should be personalized, with full knowledge of the patient's life expectancy, pleural space physiology, risks and benefits of each approach, and most importantly patient preferences.

Background: Chronic obstructive pulmonary disease (COPD) is a major public health challenge in Colombia, particularly among older adults. Although ICS/LABA combinations like fluticasone/salmeterol (FSC) are widely used, dual bronchodilation with umeclidinium/vilanterol (UMEC/VI) may offer clinical and economic advantages.The objective of this paper is to evaluate the long-term cost-effectiveness of UMEC/VI versus FSC in patients with moderate to severe COPD from the perspective of the Colombian healthcare system.

Methods: A Markov model with four health states (moderate, severe, very severe COPD, and death) simulated the disease course over a lifetime horizon. Clinical efficacy and utilities were derived from randomized trials and meta-analyses; costs were sourced from national databases. Deterministic and probabilistic sensitivity analyses assessed uncertainty. The economic advantage of UMEC/VI was primarily driven by its ability to reduce moderate and severe exacerbations, which represent nearly 88% of total COPD-related healthcare costs in Colombia.

Results: UMEC/VI yielded 8.74 additional QALYs compared to FSC, with an incremental cost of $7,039 USD, resulting in an ICER of $805 per QALY-well below Colombia's WTP threshold of $5,180. Sensitivity analyses confirmed model robustness; UMEC/VI remained cost-effective in 64% of simulations.

Conclusion: UMEC/VI is a highly cost-effective alternative to FSC for moderate to severe COPD in Colombia, offering improved clinical outcomes and economic value for resource-constrained health systems.

Introduction: Pulmonary hypertension associated with congenital heart disease (PAH-CHD) represents one of the leading causes of pediatric pulmonary hypertension. Within this entity, patients can be classified into distinct subgroups, each characterized by specific clinical features, pathophysiological mechanisms, and therapeutic approaches.

Areas covered: This review provides an update of the current PAH-CHD classification and outlines management strategies in accordance with the most recent international recommendations. Particular attention is given to the ongoing debate regarding operability in patients with open shunts and some degree of increased pulmonary vascular resistance, and key gaps in knowledge are highlighted.

Expert opinion: In PAH-CHD, treatment strategies are relatively straightforward in patients with low PVR, where shunt closure is recommended, and in Eisenmenger syndrome, where shunt patency is maintained and pulmonary vasodilators are indicated; however, the management of patients with open shunts and moderately elevated PVR remains highly challenging. Operability in this intermediate group is currently determined by invasive hemodynamic assessment, despite methodological limitations, highlighting the urgent need for reliable noninvasive markers and prospective clinical studies in late-referred patients. Emerging therapies such as sotatercept, along with the development of novel biomarkers to assess pulmonary vascular disease severity may have the potential to redefine operability criteria and expand therapeutic options.