Curr Opin Pulm Med [JOURNAL]
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200 papers
Nonsteroid treatment options in (pulmonary) sarcoidosis. When to consider and why?
Spagnolo P, Miedema J
Curr Opin Pulm Med · 2026 Jul · PMID 42396698 · Publisher ↗
PURPOSE OF REVIEW: Sarcoidosis requires treatment in 30-50% of cases. According to current guidelines, corticosteroids (CS) are the initial drugs of choice, particularly for patients with major organ involvement or when...
PURPOSE OF REVIEW: Sarcoidosis requires treatment in 30-50% of cases. According to current guidelines, corticosteroids (CS) are the initial drugs of choice, particularly for patients with major organ involvement or when rapid symptom relief is required. However, CS use is associated with substantial toxicity even at low dose. Here, we discuss the evidence that argues against the traditional CS-centred model of sarcoidosis treatment. RECENT FINDINGS: A recent prospective trial of patients with pulmonary sarcoidosis showed that high-dose (40 mg) prednisolone was not superior to a lower dose (20 mg) in improving outcomes or health-related quality of life and was associated with similar adverse effects. In addition, in patients with pulmonary sarcoidosis, initial treatment with methotrexate has been shown to be noninferior to prednisone with regard to the change from baseline to week 24 in the percentage of the predicted forced vital capacity (FVC). SUMMARY: The appreciation of CS adverse effects coupled with the observation that methotrexate is as effective as prednisone as initial treatment in pulmonary sarcoidosis supports a paradigm shift in the treatment of pulmonary sarcoidosis that moves away from CS. Differences in the side-effect profile between methotrexate and prednisone may inform shared decision making by providers and patients about the appropriate treatment approach.
Multidisciplinary approach in cardiac sarcoidosis: to biopsy or not?
Pericao A, Sharma R
Curr Opin Pulm Med · 2026 Jul · PMID 42396691 · Publisher ↗
PURPOSE OF REVIEW: Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality, yet its diagnosis remains challenging due to heterogeneous clinical presentations and patchy myocardial involvement. Alt...
PURPOSE OF REVIEW: Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality, yet its diagnosis remains challenging due to heterogeneous clinical presentations and patchy myocardial involvement. Although endomyocardial biopsy has historically been regarded as the diagnostic gold standard, its limited sensitivity, tendency to provide false negative and inconclusive results and procedural risks have led to increasing reliance on noninvasive imaging. This review assesses the contemporary role of endomyocardial biopsy (EMB) within a multidisciplinary diagnostic framework and evaluates whether tissue diagnosis remains necessary in modern clinical practice. RECENT FINDINGS: Recent studies highlight the expanding role of cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in diagnosing, phenotyping, and risk stratifying CS. Targeted biopsy strategies guided by imaging or electroanatomical mapping have demonstrated improved diagnostic yield compared with random sampling. Multidisciplinary team-based decision-making has emerged as a key determinant in selecting patients for biopsy, particularly when histological confirmation is likely to influence immunosuppressive therapy, device implantation, or prognostic assessment. SUMMARY: EMB retains an important but selective role in CS. Integration of multimodality imaging and multidisciplinary assessment optimizes patient selection, enhances procedural safety, and ensures that biopsy findings meaningfully inform management. Future research should refine biopsy indications and integrate imaging with molecular and biomarker-based approaches to improve diagnostic accuracy and prognostication.
Low diffusion capacity in pulmonary hypertension.
Nossent EJ, Vonk Noordegraaf A
Curr Opin Pulm Med · 2026 Jul · PMID 42389860 · Publisher ↗
PURPOSE OF REVIEW: The diffusion capacity of the lungs for carbon monoxide (DLCO) is increasingly recognized as important diagnostic and prognostic marker in pulmonary hypertension. The review summarizes this diagnostic...
PURPOSE OF REVIEW: The diffusion capacity of the lungs for carbon monoxide (DLCO) is increasingly recognized as important diagnostic and prognostic marker in pulmonary hypertension. The review summarizes this diagnostic role and provides an overview of the clinical implications, potential underlying pathophysiology and impact of a decreased DLCO in different forms of pulmonary hypertension. RECENT FINDINGS: When in the diagnostic work-up of pulmonary arterial hypertension (PAH) a strongly lowered DLCO is found one must be aware of other causes and the diagnosis idiopathic PAH should be reconsidered. Left heart disease, lung disease, (peripheral) chronic thrombo-embolic pulmonary hypertension, underlying connective tissue disease and pulmonary veno-occlusive disease belong to the differential diagnosis. If all of these subforms of pulmonary hypertension are excluded and the patient fits the clinical profile the nowadays so called "Lung phenotype" should be considered. In general, a severely decreased DLCO is associated with a worse prognosis in different sub forms of pulmonary hypertension. SUMMARY: Reduced DLCO in pulmonary hypertension has important implications for clinical practice and research by improving diagnostic accuracy, supporting patient phenotyping, and identifying high-risk populations. Integration of DLCO into routine pulmonary hypertension assessment, registries, and future studies may enhance disease classification and facilitate more individualized diagnostic and therapeutic strategies.
Toward precision imaging in interstitial lung disease: advances in quantitative imaging and artificial intelligence.
Marrocchio C, Ligorio M, Sverzellati N
Curr Opin Pulm Med · 2026 Jun · PMID 42310967 · Publisher ↗
PURPOSE OF REVIEW: To discuss the most recent developments in quantitative imaging and artificial intelligence (AI) applications in interstitial lung diseases (ILD). RECENT FINDINGS: Aided by technical developments in th...
PURPOSE OF REVIEW: To discuss the most recent developments in quantitative imaging and artificial intelligence (AI) applications in interstitial lung diseases (ILD). RECENT FINDINGS: Aided by technical developments in the field, AI applications in chest imaging are increasingly being investigated, with recent algorithms showing improved performance compared with earlier techniques. This review article discusses the various roles of AI in fibrotic ILD, including diagnosis, characterization, quantification, and prognostication. SUMMARY: Increasing evidence supports the utility of quantitative CT and AI algorithms in improving visual assessment, increasing sensitivity and inter-observer agreement, as well as providing prognostic stratification in patients with a broad range of ILD. Nevertheless, the routine clinical application of these tools remains limited.
Oxygen therapy in interstitial lung disease - navigating benefit and burden.
Guler SA, Khor YH, Holland AE … +1 more , Ekström M
Curr Opin Pulm Med · 2026 Jun · PMID 42274204 · Publisher ↗
PURPOSE OF REVIEW: Oxygen therapy is a key component of interstitial lung disease (ILD) management. This review summarizes the current evidence and explores how to balance its benefits and burdens in people with ILD. REC...
PURPOSE OF REVIEW: Oxygen therapy is a key component of interstitial lung disease (ILD) management. This review summarizes the current evidence and explores how to balance its benefits and burdens in people with ILD. RECENT FINDINGS: Hypoxemia frequently occurs in ILD and is associated with worse prognosis, but the extent to which oxygen therapy modifies outcomes remains uncertain. Observational findings suggest home oxygen therapy may reduce acute exacerbations and hospitalizations in people with ILD with a life-expectancy of more than 1 year. Ambulatory oxygen can improve symptoms and health-related quality of life in some patients; however, recent evidence indicates that portable oxygen concentrators may not improve daily oxygenation, symptoms, or physical activity. In patients with isolated exertional or nocturnal desaturation or significant respiratory symptoms with hypoxemia, careful consideration of individual benefit versus burden is essential within a shared decision-making framework. High-flow oxygen therapy is effective for acute respiratory failure, but its role in palliative care, pulmonary rehabilitation, and especially in the home environment, are areas of ongoing investigation. SUMMARY: Oxygen therapy can support symptom relief in ILD, but its impact on long-term outcomes is unclear. High-quality evidence remains sparse, and advances in oxygen delivery technologies are needed to improve effectiveness while minimizing burden.
Preclinical and clinical advances in pulmonary hypertension associated with systemic sclerosis.
Birnhuber A, Zeder K, Kwapiszewska G
Curr Opin Pulm Med · 2026 Jun · PMID 42267527 · Publisher ↗
PURPOSE OF REVIEW: Systemic sclerosis (SSc) is a chronic, severe autoimmune disease characterized by progressive fibrosis of the skin and internal organs. Pulmonary (arterial) hypertension (P(A)H) is a common complicatio...
PURPOSE OF REVIEW: Systemic sclerosis (SSc) is a chronic, severe autoimmune disease characterized by progressive fibrosis of the skin and internal organs. Pulmonary (arterial) hypertension (P(A)H) is a common complication and leading cause of death. This review highlights preclinical and clinical advances of recent years that contribute to our understanding of pathomechanisms, risk stratification, treatment and potential targets in SSc-P(A)H. RECENT FINDINGS: As SSc-PH emerges from a complex interplay of immune dysregulation, endothelial injury, metabolic reprogramming and fibroproliferative remodeling, an integrated approach to early detection, combining refined cardiac imaging metrics, circulating and omics-based biomarkers, and clinical stratifiers such as age and timing of symptom onset, is increasingly feasible. Recent literature highlights mechanistic targets for therapy and also practical tools for sharpening screening algorithms to reduce unnecessary right heart catheterization. Exercise testing and detailed right heart phenotyping yield promise for early disease diagnosis. Four randomized controlled trials in PAH provide (indirect) evidence on efficacy and safety of activin signaling inhibitor, Sotatercept in SSc-PAH. SUMMARY: Recent years have brought major preclinical and clinical advances improving diagnosis and management of SSc-P(A)H. Large-scale multi-omics analyses, and novel treatment targets offer further advances in the field.
Advancing lung transplantation: current challenges and future directions.
Lehr CJ, Juvet SC
Curr Opin Pulm Med · 2026 Jul · PMID 42205001 · Publisher ↗
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Association between upper airway obstruction and pulmonary hypertension in children with Down syndrome.
Guy K, Isaiah A
Curr Opin Pulm Med · 2026 May · PMID 42199076 · Full text
PURPOSE OF REVIEW: Down syndrome (DS) is the most common nonlethal chromosomal aneuploidy, affecting 1 in 700 live births. Pulmonary hypertension (PH) occurs in approximately 25% of children with DS and contributes to a...
PURPOSE OF REVIEW: Down syndrome (DS) is the most common nonlethal chromosomal aneuploidy, affecting 1 in 700 live births. Pulmonary hypertension (PH) occurs in approximately 25% of children with DS and contributes to a 10% mortality rate within 3 years of diagnosis. Despite obstructive sleep apnea (OSA) affecting up to 80% of children with DS, the specific contribution of upper airway obstruction to PH in this population remains poorly characterized. This review synthesizes current evidence to address that gap. RECENT FINDINGS: Children with DS develop multilevel upper airway obstruction due to craniofacial dysmorphology, relative macroglossia, hypotonia, and reduced peripheral chemosensitivity. OSA-driven chronic hypoxemia promotes pulmonary vascular remodeling, with 87% of recurrent PH cases classified as WHO Group III. Echocardiographic diagnosis is limited by chronic lung disease. NT-proBNP is the most reliable biomarker in DS. Adenotonsillectomy reduces apnea severity, though evidence of a reduction in mean pulmonary arterial pressure in DS is lacking. Endothelin receptor antagonists show functional benefit, while sildenafil appears less effective in DS-specific analyses. SUMMARY: No DS-specific PH staging system exists, representing a critical gap. Future research should quantify the impact of airway interventions on pulmonary hemodynamics, develop DS-tailored biomarkers, and optimize pharmacologic regimens in this molecularly distinct population.
Molecular mechanisms of environmental risk factors for interstitial lung disease.
Goobie GC
Curr Opin Pulm Med · 2026 May · PMID 42199064 · Publisher ↗
PURPOSE OF REVIEW: Interstitial lung disease (ILD) comprises a diverse group of conditions characterized by lung inflammation and fibrosis. Cumulative lifetime exposures (i.e. the exposome) contribute to ILD onset and pr...
PURPOSE OF REVIEW: Interstitial lung disease (ILD) comprises a diverse group of conditions characterized by lung inflammation and fibrosis. Cumulative lifetime exposures (i.e. the exposome) contribute to ILD onset and progression by interacting with genetic susceptibility and influencing multiple molecular pathways. This review summarizes current evidence evaluating how environmental exposures interact across the genome, epigenome, transcriptome, proteome, metabolome, and microbiome to drive ILD pathogenesis. RECENT FINDINGS: Environmental exposures, including air pollution, influence ILD risk through interactions with genetic factors that modify disease susceptibility. Epigenetic mechanisms, particularly DNA methylation, reflect key pathways through which exposures may contribute to ILD onset and progression and serve as sensitive biomarkers of environmental injury. Exposure-associated molecular alterations can be detected across multiple omic layers, including transcriptomic, proteomic, and metabolomic profiles. In parallel, exposures like cigarette smoking, silica, and air pollution influence the respiratory microbiome, with potential downstream effects on immune responses and fibrogenesis. Integrating these findings highlights environmentally-sensitive pathways that may represent novel targets for therapeutic modulation. SUMMARY: Integration of exposomic and multiomic molecular frameworks offers new opportunities to improve ILD risk stratification, prognostication, and precision therapeutic development, while also strengthening our mechanistic understanding of environmentally-mediated disease.
Functional testing for interstitial lung disease in 2026.
Dowman L, Marshall E, Khor YH
Curr Opin Pulm Med · 2026 May · PMID 42158974 · Publisher ↗
PURPOSE OF REVIEW: This review synthesizes the role of functional testing in the care of interstitial lung disease (ILD), evaluating the clinical utility of current approaches and discussing innovative strategies that ma...
PURPOSE OF REVIEW: This review synthesizes the role of functional testing in the care of interstitial lung disease (ILD), evaluating the clinical utility of current approaches and discussing innovative strategies that may enhance patient monitoring and management. RECENT FINDINGS: The 6-min walk test (6MWT) remains the most studied and comprehensive assessment capturing functional and prognostic information, as well as outcomes related to interventions and treatments, in people with ILD. Step tests and sit-to-stand tests offer space-efficient alternatives with clinically relevant functional and prognostic insights. Current approaches are limited by accessibility and the ability to reflect patients' real-world performance. Advances in digital health and remote monitoring offer new opportunities. Physical activity trackers are widely available with step count and physical activity levels being associated with mortality, and are increasing used to evaluate effectiveness of pharmacological and nonpharmacological interventions. Smart home technologies is an emerging approach with potential for monitoring functional status, although evidence is limited. SUMMARY: Functional performance in people with ILD can be assessed using a range of approaches. With further research, remote functional testing, physical activity monitoring, and smart home technologies are poised to optimize the assessment of functional status in people with ILD.
Recent advances in the clinical management of end-stage pediatric pulmonary hypertension.
van der Have O, Hopper RK, Kameny RJ … +1 more , Tran-Lundmark K
Curr Opin Pulm Med · 2026 May · PMID 42158971 · Publisher ↗
PURPOSE OF REVIEW: This review aims to give an overview of recent advances in the clinical management of children <18 years of age with end-stage pulmonary hypertension refractory to conventional medical therapy. RECENT...
PURPOSE OF REVIEW: This review aims to give an overview of recent advances in the clinical management of children <18 years of age with end-stage pulmonary hypertension refractory to conventional medical therapy. RECENT FINDINGS/SUMMARY: The increased awareness and characterization of pediatric pulmonary vascular disease has amounted more data toward creating an accurate, and comprehensive, risk prediction tool. This underscores the importance of serial outpatient re-assessment, as early consideration of advanced pharmaceutical and interventional therapies, as well as lung transplantation, improves outcomes in children. Despite the emergence and approval of new therapies against pulmonary hypertension in adults, pediatric-specific complications have not yet been adequately explored. It is, however, encouraging that several trials are ongoing to address this issue. Interventional strategies to unload the right ventricle are increasingly being utilized, although evidence remains scarce in this area. Extra-corporeal membrane oxygenation may, in addition to being a bridge to lung transplantation in well-selected patients, be considered as a bridge to catheter-based or surgical interventions. Management of pediatric right ventricular failure in the setting of advanced pulmonary hypertension is a truly complex clinical challenge at the intersection of cardiac, vascular and respiratory physiology and requires careful integration of invasive hemodynamic assessment, pulmonary vasodilator therapy, ventilatory strategy, and timely consideration of mechanical circulatory support.
Precision immunosuppression in adult lung transplantation: are we there yet?
Jaksch P, Benazzo A, Murakoezy G
Curr Opin Pulm Med · 2026 Jul · PMID 42144950 · Publisher ↗
PURPOSE OF REVIEW: Long-term outcomes after adult lung transplantation remain limited by rejection, infection, and toxicity related to immunosuppressive therapy. Conventional protocol-based immunosuppression fails to acc...
PURPOSE OF REVIEW: Long-term outcomes after adult lung transplantation remain limited by rejection, infection, and toxicity related to immunosuppressive therapy. Conventional protocol-based immunosuppression fails to account for substantial interindividual variability in immune risk, drug metabolism, and susceptibility to complications. This review is timely as emerging biomarkers and digital tools promise to shift lung transplantation toward individualized immune management. RECENT FINDINGS: Recent studies highlight the role of Torque Teno virus (TTV) load as a surrogate marker of net immunosuppression, donor-derived cell-free DNA (dd-cfDNA) as a sensitive indicator of graft injury, and tissue-bound donor-specific antibodies as markers of localized alloimmune activity. Pharmacogenomic profiling and immunomodulatory strategies such as extracorporeal photopheresis further enable risk-adapted therapy. Integration of blood and BAL-based biomarkers allows earlier detection of subclinical rejection and infection risk. SUMMARY: Precision immunosuppression in lung transplantation is transitioning from concept to early clinical implementation. Combining clinical risk stratification with immune and graft-injury biomarkers may allow safer immunosuppression minimization and improved long-term outcomes, although prospective validation is still required.
The changing face of lung transplant candidates.
Leuzzi FR, Clausen ES, Dilling DF
Curr Opin Pulm Med · 2026 Jul · PMID 42144949 · Publisher ↗
PURPOSE OF REVIEW: Lung transplant remains the ultimate life-saving therapy for people with progressive end-stage lung disease. It is important to highlight the evolution of the field in the United States, as its develop...
PURPOSE OF REVIEW: Lung transplant remains the ultimate life-saving therapy for people with progressive end-stage lung disease. It is important to highlight the evolution of the field in the United States, as its development has had varying impacts on the different lung transplant candidate groups. This review seeks to synthesize current evidence on the evolution of transplantation across various patient groups, reflecting advances in medical therapies, the implementation of the new composite allocation score (CAS) and trends in lung transplant candidate groups over the years. RECENT FINDINGS: The proportion of waitlisted candidate with chronic obstructive pulmonary disease (COPD, group A) and cystic fibrosis (group C) has declined, reflecting the impact of novel therapeutics and advanced procedural interventions. In contrast, restrictive lung disease patients (group D) now account for most lung transplant recipients, which is likely reflective of our increased use of extracorporeal membrane oxygen (ECMO) for bridging and transplant centers expanded eligibility. Pulmonary hypertension patients (group B) continue to face high waitlist mortality despite the change to the new allocation scoring system. SUMMARY: Advancements in medical therapies and the new composite allocation scoring system has altered both the timing and outcomes for various transplant candidate groups. It is important that we continue to study these findings to optimize patient outcomes and organ allocation.
Remote exercise assessment in pulmonary hypertension.
Appenzeller P, Jeffery D, Toshner M
Curr Opin Pulm Med · 2026 May · PMID 42093162 · Publisher ↗
PURPOSE OF REVIEW: In pulmonary arterial hypertension (PAH), assessment of exercise provides important prognostic information. Recently, digital alternatives to traditional outcome measures, including digital versions of...
PURPOSE OF REVIEW: In pulmonary arterial hypertension (PAH), assessment of exercise provides important prognostic information. Recently, digital alternatives to traditional outcome measures, including digital versions of the six-minute walk test (6MWT), have been proposed. This review discusses existing methods of remote exercise assessment in PAH. RECENT FINDINGS: Summary metrics from actigraphy (e.g. daily steps) show promise on a population level but show high variability (e.g. related to seasonality) that may obscure clinically important changes. Conversely, digital structured exercise tests (6MWT) have proven safe, accurate compared to gold-standard tests and well-accepted by patients. Implementation and underlying algorithms vary, depending on whether tests are performed indoors or outdoors, along fixed or free courses, using accelerometery or GPS, and are delivered through app-only or app-and-wearable platforms. Integration of physiological data from wearables enhance digital 6MWT performance and hold promise as longitudinal endpoints. Key challenges include continued patient adherence and rigorous pre-processing of the raw data to ensure sustained data quality. SUMMARY: Future studies are needed to demonstrate the ability of the digital 6MWT or alternative exercise measures to reflect disease severity, show sensitivity to change and establish minimal clinically important differences for them to be implemented in clinical care for longitudinal monitoring.
The clinical relevance of chest computed tomography imaging in pulmonary hypertension associated with lung diseases.
Johnson SW, Rahaghi FN, Estépar RSJ
Curr Opin Pulm Med · 2026 May · PMID 42083403 · Full text
PURPOSE OF REVIEW: The purpose of this review is to describe the use of chest computed tomography (CT) data to expand sub-phenotyping of pulmonary hypertension associated with chronic lung disease (Group 3 pulmonary hype...
PURPOSE OF REVIEW: The purpose of this review is to describe the use of chest computed tomography (CT) data to expand sub-phenotyping of pulmonary hypertension associated with chronic lung disease (Group 3 pulmonary hypertension) and inform identification of effective treatment. RECENT FINDINGS: In the last 5 years, breakthroughs in clinical pulmonary hypertension research highlight the importance of chest CT data to inform disease trajectory and mortality risk. In presumed idiopathic pulmonary arterial hypertension (Group 1 pulmonary hypertension), a Group 1 'lung phenotype' with abnormal CT chest findings such as emphysema and fibrosis, experiences a mortality risk similar to that of Group 3 disease. Post hoc analyses of Group 3 pulmonary hypertension clinical trials highlight CT abnormalities to inform adverse treatment response, with implications for additional failed clinical trials to date. In fact, pulmonary hypertension guidelines emphasize the critical role for acquisition of standardized high-resolution CT data at pulmonary hypertension diagnosis and clinical trial enrollment. SUMMARY: Chest CT imaging is critical in the clinical management of pulmonary hypertension associated with chronic lung disease. Future research will not only incorporate CT data into Group 3 pulmonary hypertension phenotyping research but also consider treatment effect visualization on the lung parenchyma and pulmonary arterial vasculature as a novel clinical trial endpoint.
Promising signalling pathways for the treatment of pulmonary arterial hypertension.
Budhram B, Bonnet S, Weatherald J
Curr Opin Pulm Med · 2026 May · PMID 42083394 · Publisher ↗
PURPOSE OF REVIEW: Improved understanding of the complex and interconnected mechanisms driving pulmonary arterial hypertension (PAH) has expanded therapeutic development beyond the traditional vasodilator pathways. This...
PURPOSE OF REVIEW: Improved understanding of the complex and interconnected mechanisms driving pulmonary arterial hypertension (PAH) has expanded therapeutic development beyond the traditional vasodilator pathways. This review summarizes recently established and emerging signalling pathways that may influence the next generation of targeted PAH therapies. RECENT FINDINGS: The transforming growth factor-β (TGF-β) superfamily has emerged as a fourth major therapeutic pathway. Therapies that target this pathway, such as the activin signalling inhibitor sotatercept, have demonstrated significant clinical and hemodynamic benefits in large randomized clinical trials. Additional promising strategies focus on receptor tyrosine kinases - particularly platelet-derived growth factor receptor signalling - as well as hypoxia-related and metabolic reprogramming pathways. Growing evidence also supports the role of immune dysregulation, hormonal and neurohormonal signalling, and epigenetic, genetic, and cell-cycle abnormalities in the development of PAH. SUMMARY: The therapeutic landscape in PAH is shifting toward mechanism-based therapies with the potential to modify disease progression. Continued translational research and upcoming clinical trials will be essential to define appropriate patient selection, optimize therapeutic strategies, and determine the short- and long-term benefit of these therapies on clinical and survival outcomes.
Strategies to address donor organ shortages in lung transplantation.
Siebiger G, Cypel M
Curr Opin Pulm Med · 2026 Jul · PMID 42059382 · Publisher ↗
PURPOSE OF REVIEW: Lung transplantation remains limited by donor organ scarcity. This review summarizes recent strategies with the direct potential to expand lung availability, including 10°C hypothermic preservation, do...
PURPOSE OF REVIEW: Lung transplantation remains limited by donor organ scarcity. This review summarizes recent strategies with the direct potential to expand lung availability, including 10°C hypothermic preservation, donation after circulatory death (DCD), ex vivo lung perfusion (EVLP), and expanded utilization of elderly donors. RECENT FINDINGS: Clinical translation of 10°C static preservation has enabled prolonged storage, including preservation for up to 24 h without clear adverse short- or intermediate-term consequences, and the prospect of semi-elective transplantation. Contemporary evidence supports broader use of DCD lungs, particularly controlled DCD, with reassuring long-term outcomes despite small differences in early risk in some cohorts; uncontrolled DCD remains promising in highly organized EVLP-based programs, whereas thoracoabdominal normothermic regional perfusion requires further prospective evaluation. EVLP continues to increase utilization of marginal lungs, and the largest single-center series reported outcomes comparable to conventional transplantation. In parallel, carefully selected septuagenarian and even octo-/nonagenarian donors have demonstrated encouraging short- and long-term clinical outcomes. SUMMARY: Donor shortage in lung transplantation can be mitigated by combining logistics-extending preservation strategies, broader donor pathways, advanced graft assessment, and careful expansion of donor acceptance criteria. Standardized, prospective, multicenter clinical trials are still frequently lacking and represent an area for future improvement.
Genetic variants in pulmonary hypertension associated with chronic obstructive pulmonary disease.
Foris V, Cho MH, Boueiz A
Curr Opin Pulm Med · 2026 Apr · PMID 42046906 · Publisher ↗
PURPOSE OF REVIEW: To synthesize emerging evidence supporting genetic susceptibility to pulmonary vascular phenotypes in chronic obstructive pulmonary disease (COPD) and to provide a rationale for focused genomic investi...
PURPOSE OF REVIEW: To synthesize emerging evidence supporting genetic susceptibility to pulmonary vascular phenotypes in chronic obstructive pulmonary disease (COPD) and to provide a rationale for focused genomic investigation of pulmonary hypertension associated with COPD (PH-COPD). RECENT FINDINGS: Multiancestry genome-wide association studies and integrative genomic analyses have identified COPD risk loci involved in pathways related to lung development, extracellular matrix remodeling, angiogenesis, immune signaling, and hypoxia responses, processes that intersect with pulmonary vascular biology. Concurrent advances in pulmonary arterial hypertension (PAH) genetics demonstrate that rare pathogenic variants in developmental and endothelial signaling genes produce vascular phenotypes often accompanied by reduced diffusing capacity, parenchymal abnormalities, and proliferative vasculopathy. Consistent with these observations, data from independent PAH cohorts reveal phenotypic overlap and biological heterogeneity between group 1 and group 3 classifications. Collectively, these findings suggest that a subset of COPD patients with pulmonary hypertension may harbor unrecognized genetic susceptibility influencing pulmonary vascular remodeling. However, dedicated genetic studies specifically examining PH-COPD remain limited. SUMMARY: PH-COPD may represent, in part, a genetically influenced disease that extends beyond the traditional PH group boundaries. Systematic genomic sequencing coupled with clinical, imaging, and physiological phenotyping will be essential to identify biologically defined subgroups and guide precision therapeutic strategies.
Update on pleural mesothelioma.
Tan DCX, Chin WL, Lee YCG
Curr Opin Pulm Med · 2026 Jul · PMID 41982104 · Publisher ↗
PURPOSE OF REVIEW: Pleural mesothelioma remains a universally lethal cancer with a rising global burden. This underscores the need for pulmonologists to stay abreast of evolving diagnostic and therapeutic strategies. REC...
PURPOSE OF REVIEW: Pleural mesothelioma remains a universally lethal cancer with a rising global burden. This underscores the need for pulmonologists to stay abreast of evolving diagnostic and therapeutic strategies. RECENT FINDINGS: This review highlights paradigm shifts in nomenclature, including recognition of mesothelioma in-situ as a pre-invasive entity made possible by molecular markers defining malignant transformation. High impact randomized clinical trials have provided evidence that radical surgical resection, via extrapleural pneumonectomy or extended pleurectomy/decortication, negatively impacts survival and quality of life. Dual immunotherapy (of nivolumab and ipilimumab) is now incorporated as first-line systemic therapy especially for sarcomatoid-containing mesothelioma. Addition of pembrolizumab to standard pemetrexed and platinum chemotherapy provides modest benefits. Emerging approaches are highlighted and encompass molecularly targeted, metabolic, intrapleural, and artificial intelligence (AI)-based strategies. SUMMARY: These developments underline a move away from aggressive surgical cytoreduction towards more biologically-informed, less invasive management and earlier detection in high-risk cohorts, while embracing biomarker-driven systemic and intrapleural therapies to optimize outcomes. Future research should prioritize mesothelioma-specific trials to define the role and sequencing of perioperative immunotherapy and novel agents. AI tools may assist disease diagnosis, prognostication, and treatment selection.
Robotic-assisted bronchoscopy for lung nodules and masses - can it replace CT-guided transthoracic biopsy?
Ko J, Bedi H, Chang J
Curr Opin Pulm Med · 2026 Jul · PMID 41925197 · Publisher ↗
PURPOSE: Robotic-assisted bronchoscopy is a rapidly evolving tool for the diagnosis of peripheral lung nodules. This review examines literature from the past 18 months, comparing robotic-assisted bronchoscopy's performan...
PURPOSE: Robotic-assisted bronchoscopy is a rapidly evolving tool for the diagnosis of peripheral lung nodules. This review examines literature from the past 18 months, comparing robotic-assisted bronchoscopy's performance with CT-guided transthoracic lung biopsy.Recent findings: Recent studies confirm that robotic-assisted bronchoscopy has a noninferior diagnostic yield and a better safety profile than CT-guided transthoracic lung biopsy. The clinical utility of robotic-assisted bronchoscopy may be further expanded by its compatibility with various biopsy tools, integrated imaging with navigation, capacity for sampling multiple lesions in a single procedure, and ongoing development of associated ablative therapies. SUMMARY: Robotic-assisted bronchoscopy demonstrates a comparable diagnostic yield and a superior safety profile compared to CT-guided transthoracic lung biopsy. The additional features permitted in robotic-assisted bronchoscopy may expand its clinical utility in the future.
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