Curr Opin Pulm Med [JOURNAL]
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200 papers
Analysis of pleural fluid biomarkers for diagnosis of malignant pleural effusion and molecular characterization of lung cancer: a review.
Schwalk AJ, Abu-Rmaileh M, Grosu HB
Curr Opin Pulm Med · 2026 Jul · PMID 41873502 · Publisher ↗
PURPOSE OF REVIEW: Malignant pleural effusion (MPE) is a common complication of advanced lung cancer and often represents the first sign of malignancy. Conventional diagnostic methods, including cytology and pleural biop...
PURPOSE OF REVIEW: Malignant pleural effusion (MPE) is a common complication of advanced lung cancer and often represents the first sign of malignancy. Conventional diagnostic methods, including cytology and pleural biopsy, have limited sensitivity. This review provides a timely assessment of emerging pleural fluid biomarkers and their utility in differentiating malignant from benign effusions, as well as their role in guiding molecular characterization of lung cancer to improve diagnostic accuracy and therapeutic decision-making. RECENT FINDINGS: Recent studies highlight the diagnostic and molecular profiling potential of circulating tumor DNA (ctDNA), microRNAs, proteins, and metabolites detectable in pleural fluid. Advances in next-generation sequencing and liquid biopsy technologies have enabled noninvasive detection of actionable mutations (EGFR, ALK, KRAS, PD-L1), enhancing molecular profiling directly from pleural samples. Integration of multiple biomarkers shows promise for improving sensitivity and specificity compared to cytology alone. SUMMARY: Pleural fluid biomarker analysis offers a minimally invasive, clinically relevant approach for diagnosing MPE and identifying molecular targets in lung cancer. Further standardization and validation of testing protocols are needed, but these advances hold potential to refine early diagnosis, guide targeted therapies, and personalize management strategies for patients with lung cancer-related effusions.
A practical framework for physicians and researchers to assess diagnostic bronchoscopy technologies in lung cancer.
Ost DE
Curr Opin Pulm Med · 2026 Jul · PMID 41873499 · Publisher ↗
PURPOSE OF REVIEW: Advancements in bronchoscopic technologies have improved the diagnosis of peripheral pulmonary nodules, yet inconsistent methodology and outcome definitions in observational studies hinder interpretati...
PURPOSE OF REVIEW: Advancements in bronchoscopic technologies have improved the diagnosis of peripheral pulmonary nodules, yet inconsistent methodology and outcome definitions in observational studies hinder interpretation and comparison. RECENT FINDINGS: The American Thoracic Society (ATS) and American College of Chest Physicians (ACCP) have published a Delphi consensus definition of diagnostic yield and reporting standards for diagnostic testing in respiratory medicine. Recognition that bronchoscopy is a multi-disease test has highlighted limitations of traditional dichotomous accuracy metrics. SUMMARY: This review summarizes these methodologic advances and provides a practical framework for clinicians to critically appraise diagnostic bronchoscopy studies, compare technologies, and apply results to individual patients with suspected lung cancer. Emphasis is placed on appropriate reference standards, recognition of bronchoscopy as a multi-disease test, and the superiority of disease specific sensitivity over diagnostic yield for cross-study comparisons.
Primary prophylaxis and treatment of venous thromboembolism in malignancy with focus on lung cancer: a review of current evidence.
Pinto FG, Voltani DL, Rojas-Hernandez CM
Curr Opin Pulm Med · 2026 Jul · PMID 41783954 · Publisher ↗
PURPOSE OF REVIEW: Cancer-associated thrombosis (CAT) is a significant cause of mortality in oncology, particularly in lung cancer. The clinical management requires a careful balance between preventing venous thromboembo...
PURPOSE OF REVIEW: Cancer-associated thrombosis (CAT) is a significant cause of mortality in oncology, particularly in lung cancer. The clinical management requires a careful balance between preventing venous thromboembolism (VTE) and minimizing bleeding risks. The aim of this review is to provide the latest evidenced based-approach for primary and secondary prevention of CAT. RECENT FINDINGS: Results from randomized clinical trials, such as TARGET-TP, CASSINI, and AVERT demonstrated that low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) reduce VTE incidence in high-risk ambulatory patients (Khorana score ≥2). Lung-cancer-specific data from FRAGMATIC showed that although VTE risk is halved, there is no overall survival benefit, and routine prophylaxis is not recommended for unselected patients, which aligns with current guidelines. For VTE treatment, randomized trials including CARAVAGGIO, SELECT-D, and ADAM VTE showed that DOACs are non-inferior to LMWH with similar major bleeding rates, although some DOACs increase non-major gastrointestinal or genitourinary bleeding. Invasive approaches such as mechanical thrombectomy and catheter-directed thrombolysis remain reserved for life-threatening presentations. SUMMARY: Pharmacotherapy for prevention of CAT in lung cancer must be individualized. DOACs have emerged as a practical and effective alternative to LMWH for both primary and secondary VTE prophylaxis after assessing risk-benefit.
Reframing lung transplantation through a sustainability lens.
Tisekar O, Doig CA, Patterson CM
Curr Opin Pulm Med · 2026 Jul · PMID 41783953 · Publisher ↗
PURPOSE OF REVIEW: Lung transplantation is conspicuously resource intensive, yet the carbon footprint of solid organ transplantation, and lung transplantation in particular, remains relatively unmapped. Moreover, there i...
PURPOSE OF REVIEW: Lung transplantation is conspicuously resource intensive, yet the carbon footprint of solid organ transplantation, and lung transplantation in particular, remains relatively unmapped. Moreover, there is growing evidence that climate change adversely affects lung transplant recipients, directly and indirectly. This review explores opportunities to integrate sustainable practices across the lung transplantation pathway, with the dual aims of reducing environmental impact and reducing recipient morbidity and mortality. RECENT FINDINGS: Published literature outlines mitigation strategies to reduce the drivers of climate change, and adaptation strategies to modify the hazardous effects of the climate crisis on healthcare services. Opportunities to create "green chains" of transplant care start with appropriate recipient and donor selection, with both elements optimised to maximise operative success and avoid donor organ discard. The peri-operative phase offers scope for decarbonisation via the reduction of anaesthetic gas emissions, green procurement, and waste reduction. In the post-transplant phase, enhanced recovery after surgery (ERAS) programmes feed into longer term surveillance and care delivery, with increasing opportunities for telemedicine and noninvasive allograft monitoring, to reduce travel-related emissions. SUMMARY: The co-ordinated adoption of low-carbon, sustainable practices within lung transplantation offers a meaningful opportunity to reduce environmental harm, enhance healthcare infrastructure and workforce resilience, and improve patient outcomes in a patient cohort vulnerable to climate change. Lessons can be drawn from the global surgery movement; however, it remains the responsibility of transplant practitioners to foster a culture of environmental advocacy and to implement systematic measurement and targets for climate change and health indicators.
Immunocompromised host pneumonia: a shifting landscape of risk.
García-Martínez A, Woc-Colburn L
Curr Opin Pulm Med · 2026 May · PMID 41783951 · Publisher ↗
Immunocompromised host pneumonia (ICHP) is an infectious pneumonia that occurs in individuals with quantitative or functional impairment of host immune defenses. The heterogeneity of immune deficiencies has further diver...
Immunocompromised host pneumonia (ICHP) is an infectious pneumonia that occurs in individuals with quantitative or functional impairment of host immune defenses. The heterogeneity of immune deficiencies has further diversified the immune landscape, leading to novel patterns of infection and diagnostic dilemmas, harboring a broader, more opportunistic spectrum of pathogens, and increasing the risk of treatment failure and adverse outcomes, profoundly influencing susceptibility to pathogens, clinical presentation, and response to treatment. This review focuses on ICHP, including solid organ transplants and hematopoietic stem cell transplant recipients, patients undergoing cancer therapy, and individuals receiving immunomodulatory treatments for autoimmune diseases. These groups represent a growing segment of the population, driven by advances in transplantation, oncology, and rheumatology, but they also carry a disproportionately high burden of severe infections.
Update on diffuse idiopathic pulmonary neuroendocrine cell hyperplasia.
Majumdar U, Mazzone PJ
Curr Opin Pulm Med · 2026 Jul · PMID 41783948 · Publisher ↗
PURPOSE OF REVIEW: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a disorder characterized by neuroendocrine cell hyperplasia, tumorlets and tumors, manifesting as lung nodules, chronic cough,...
PURPOSE OF REVIEW: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a disorder characterized by neuroendocrine cell hyperplasia, tumorlets and tumors, manifesting as lung nodules, chronic cough, and airflow obstruction. Often misdiagnosed as asthma, DIPNECH lies at the cross-section of oncology, obstructive airway disease and interstitial lung disease. With the increasing use of CT scans leading to higher rates of lung nodule detection, it is important for clinicians to be familiar with DIPNECH. RECENT FINDINGS: The evidence base in DIPNECH is sparse and limited to retrospective case series. In the last 5 years, clinical experiences in large academic centers have been published describing variability in clinical presentation and pulmonary function, use of DOTATATE scans, efficacy of somatostatin analogs, and principles of surveillance imaging. SUMMARY: More awareness of DIPNECH is needed among pulmonary clinicians. Apart from the usual presentation of cough with lung nodules and spirometric obstruction in women, patients also present with dyspnea and/or restrictive patterns on PFTs. Variability in diagnosis and management is widespread. Multidisciplinary assessment is helpful in guiding management. Multicenter and multispecialty collaboration is needed to establish best practices and improve clinical management.
Pulmonary fungal infections in the age of biologics and climate change.
Corzo-Leon DE
Curr Opin Pulm Med · 2026 May · PMID 41733150 · Publisher ↗
PURPOSE OF REVIEW: This review examines the evolving epidemiology of invasive fungal infections, with emphasis in pulmonary presentations, in the context of climate change and the expanding immunomodulatory therapy use....
PURPOSE OF REVIEW: This review examines the evolving epidemiology of invasive fungal infections, with emphasis in pulmonary presentations, in the context of climate change and the expanding immunomodulatory therapy use. RECENT FINDINGS: Fungal infections represent a growing global health threat, with epidemiological patterns increasingly extending beyond traditional immunocompromised populations. Climate-driven thermal adaptation and geographic range expansion of endemic fungi, particularly Coccidioides and Histoplasma species, are exposing immunologically naive populations to infection. The higher use of new biologic therapies (IFNγ inhibitors, immune checkpoint inhibitors, CAR-T cells) is growing cohorts of patients with selective immunosuppression/immunomodulation who exhibit distinct fungal infection susceptibility patterns compared to traditional immunocompromised populations. Additionally, severe respiratory viral pandemics have demonstrated that acute viral pneumonia - independent of underlying immunosuppression - constitutes a significant risk factor for secondary invasive fungal diseases, as evidenced by IAPA and CAPA outbreaks. These shifts are occurring in parallel to increasing azole resistance and rising Pneumocystis pneumonia incidence in non-HIV populations, collectively challenging surveillance strategies, diagnostic algorithms, and therapeutic approaches. SUMMARY: This review synthesizes current evidence on how climate-mediated geographic expansion, biologic-associated immunosuppression, and virus-associated fungal infections are redefining populations at risk for pulmonary fungal infections.
From guidelines to algorithms: the future of AI-augmented asthma care.
Culver R, Johnson A, Tan L
Curr Opin Pulm Med · 2026 May · PMID 41733145 · Publisher ↗
PURPOSE OF REVIEW: Artificial intelligence (AI) has emerged as an increasingly accessible and influential resource within both public and clinical domains. The role of AI in asthma care is expanding; therefore, it must b...
PURPOSE OF REVIEW: Artificial intelligence (AI) has emerged as an increasingly accessible and influential resource within both public and clinical domains. The role of AI in asthma care is expanding; therefore, it must be discussed in the context of evolving management strategies for both clinician and patient. RECENT FINDINGS: Recent literature demonstrates that AI can integrate evidence-based guidelines with large-scale clinical data to support diagnostic interpretation and therapeutic decision-making in asthma care. Studies have shown that AI platforms can accurately assess asthma symptoms, monitor disease progression, and generate recommendations aimed at reducing exacerbations across diverse clinical scenarios. AI has also demonstrated utility in patient education and self-management support, with variable performance depending on the complexity of clinical inputs and the level of personalization required. SUMMARY: The integration of AI into asthma care offers meaningful opportunities to enhance patient engagement, improve consistency in guideline-based management, and facilitate timely escalation of therapy. For clinicians, AI may serve as a supportive decision-making tool, while for patients, it may provide guidance when healthcare access is limited. Although further validation and oversight are necessary, the increasing use of AI in asthma management has the potential to enhance overall disease control and clinical outcomes.
Breaking barriers in lung research with engineered airway epithelial cell culture models.
Schmitz MS, Taube C, Schedel M
Curr Opin Pulm Med · 2026 May · PMID 41733143 · Publisher ↗
PURPOSE OF REVIEW: The airway epithelium is a key regulator of immune responses, tissue repair, and airway remodeling in chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and idiopathic...
PURPOSE OF REVIEW: The airway epithelium is a key regulator of immune responses, tissue repair, and airway remodeling in chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis (IPF). This review evaluates engineered in vitro airway epithelial models and their value to investigate disease mechanisms, drug responses, and epithelial-mesenchymal transitions (EMT). RECENT FINDINGS: Recent studies demonstrated that different in vitro models can replicate disease-specific features, including goblet cell metaplasia, epithelial barrier disruption, and EMT, providing mechanistic insight as well as drug screening tools in asthma, COPD, and IPF. Airway epithelial cells (AEC) cultured in air-liquid interface (ALI) allow robust epithelial differentiation to perform functional and barrier integrity studies. Lung organoids provide organ-like structures that capture complex epithelial-mesenchymal crosstalk. Lung-on-chip (LoC) platforms integrate mechanical forces, dynamic airflow, and microfluidics to recapitulate in-vivo microenvironments. Each model presents specific strengths and weaknesses, making careful selection essential. SUMMARY: The strategic selection and integration of engineered airway epithelial models improves mechanistic understanding, supports preclinical drug evaluation, and reduces reliance on animal experiments. These platforms provide physiologically relevant, patient-specific systems for the advancement of translational lung research.
As-needed inhaled corticosteroids in asthma: from evidence to implementation.
Merrell E, Khurana S
Curr Opin Pulm Med · 2026 May · PMID 41733139 · Full text
PURPOSE OF REVIEW: This review aims to clarify the role of as-needed ICS through the severity spectrum of adult asthma and explores the challenges associated with implementation. This review is timely following the recen...
PURPOSE OF REVIEW: This review aims to clarify the role of as-needed ICS through the severity spectrum of adult asthma and explores the challenges associated with implementation. This review is timely following the recent US Food and Drug Administration (FDA) approval of an ICS/SABA combination inhaler. RECENT FINDINGS: In 2019, the Global Initiative for Asthma (GINA) recommended against the use of short-acting beta agonist (SABA) monotherapy and officially endorsed the use of as-needed inhaled corticosteroid with a fast-acting bronchodilator [anti-inflammatory reliever (AIR)] as the preferred strategy across all treatment steps. In 2020, the US NHLBI asthma guidelines recommended ICS+SABA at step 2, and ICS/formoterol to be used as maintenance and reliever therapy (MART) at treatment steps 3 and 4. Despite these strong recommendations, uptake of this strategy in the United States has been slow. Barriers to MART implementation are explained, and implementation strategies are reviewed. SUMMARY: Transition to a single ICS/formoterol inhaler as MART from traditional multiinhaler regimens offers the opportunity for multidomain benefits. The role of novel ICS/SABA combination inhalers remains to be determined across the continuum of asthma.
Update on allergen immunotherapy for asthma.
Looney RJ
Curr Opin Pulm Med · 2026 May · PMID 41733137 · Publisher ↗
PURPOSE OF REVIEW: The usefulness of allergen-specific immunotherapy for asthma is controversial. Publications from 2024 and 2025 on allergen immunotherapy for asthma will be reviewed. RECENT FINDINGS: A trial of house d...
PURPOSE OF REVIEW: The usefulness of allergen-specific immunotherapy for asthma is controversial. Publications from 2024 and 2025 on allergen immunotherapy for asthma will be reviewed. RECENT FINDINGS: A trial of house dust mite for asthma was strikingly positive for a subset of patients with variant alleles in chromosome 17q12-21. A trail of cockroach immunotherapy for asthma was negative based on nasal challenge. However, there were promising effects on T cells. New allergen-specific vaccines using allergoids and adjuvants are being developed in Europe and look promising for reducing the number of injections and improving safety. Small clinical trials have shown that trained immunity vaccines containing bacterial lysates can reduce wheezing in young children and animal models suggest these vaccines can affect allergen sensitization and asthma. Recent reviews of multiple clinical trials have shown allergen-specific immunotherapy can reduce symptoms and medications in asthmatic individuals but not objective measures of lung fucntion. Recent reviews of combining biologics with allergen-immunotherapy suggest improved safety. SUMMARY: Allergen-specific immunotherapy remains an important treatment for allergic rhinitis and conjunctivitis and can be used safely in patients with mild or moderate well controlled asthma. Several new approaches look promising but need a lot more work.
Emerging biologic targets in type 2 and non-type 2 asthma.
Davis AE, Rhoads S, Wechsler ME
Curr Opin Pulm Med · 2026 May · PMID 41733134 · Publisher ↗
PURPOSE OF REVIEW: Severe asthma continues to be a significant cause of global morbidity and mortality despite the dramatic change in landscape of asthma management dramatically over the last two decades, However, there...
PURPOSE OF REVIEW: Severe asthma continues to be a significant cause of global morbidity and mortality despite the dramatic change in landscape of asthma management dramatically over the last two decades, However, there are a variety of novel therapeutic agents under investigation whose goals are to enable patients with severe asthma to achieve remission. RECENT FINDINGS: New strategies in drug development include an ultra-long-acting mechanism with reduced administration frequency, biologics used in combinations, oral therapies and novel therapeutic targets. These targets include bruton tyrosine kinase, OX-40 ligand, janus kinase, CC-chemokine receptor4 (CCR4), and GATA-3, among others reviewed here. SUMMARY: Many patients have benefited tremendously from the currently available asthma biologics in achieving better symptoms control, improved quality of life, and reduced cumulative dose of systemic steroids. Despite this, most patients are unable to achieve remission, potentially related to shortcomings of these therapies in addressing asthma's heterogeneous pathophysiology. As such, a variety of novel therapeutic mechanisms and targets are being investigated and are discussed in this review.
Psychosocial challenges with transplantation.
Primera G, Anderson MR, Koons B
Curr Opin Pulm Med · 2026 Jul · PMID 41733133 · Publisher ↗
PURPOSE OF REVIEW: Psychosocial factors are associated with pre and posttransplant outcomes, but existing recommendations largely rely on small, single-center lung transplant studies or data extrapolated from other solid...
PURPOSE OF REVIEW: Psychosocial factors are associated with pre and posttransplant outcomes, but existing recommendations largely rely on small, single-center lung transplant studies or data extrapolated from other solid organ transplants, highlighting the need for an updated comprehensive review. RECENT FINDINGS: The 2021 ISHLT consensus statement on lung transplant candidate selection includes psychosocial domains in the evaluation, with few considered absolute contraindications, and instead emphasizes an individualized, holistic approach. Emerging lung-specific evidence supports the continued focus on individual psychosocial risk assessments rather than identification of broad contraindications to transplantation. This is largely due to continued reliance on single-center studies within lung transplantation, use of variable measurement tools for assessing psychosocial domains, and inconsistent associations with outcomes. We identified specific knowledge gaps in need of urgent research, including validation of lung-specific assessment tools, evaluation in larger multicenter and international studies, and development of targeted interventions to address psychosocial domains. SUMMARY: Herein, we review the prior guidelines, synthesize new lung-specific studies, and identify critical knowledge gaps to inform future research directions.
The landscape of aerosol transmission after COVID-19.
Tang JW
Curr Opin Pulm Med · 2026 May · PMID 41733130 · Publisher ↗
PURPOSE OF REVIEW: This review describes how the COVID-19 pandemic stimulated a radical shift around the concepts and definitions of aerosol transmission, and how this new understanding led to a rethink around related in...
PURPOSE OF REVIEW: This review describes how the COVID-19 pandemic stimulated a radical shift around the concepts and definitions of aerosol transmission, and how this new understanding led to a rethink around related infection control interventions that were vital to reduce the spread of SARS-CoV-2, and, potentially, other respiratory viruses. RECENT FINDINGS: A revision of the terminology for aerosol-transmitted pathogens by the WHO, together with its accompanying open access platform (ARIA), to allow users to define their own exposure scenarios and calculate related transmission risks, are just two of many multidisciplinary collaborations that have paved the way for a more effective pandemic response in the future, for aerosol-transmitted, novel pathogens. SUMMARY: A multipronged approach is needed for any next pandemic, including expertise from laboratory microbiologists and virologists, clinical infectious diseases and infection control teams, public health physicians and epidemiologists, aerosol scientists and engineers. We need to develop a rapid evidence pipeline to collate robust scientific data about any new pathogen, how it is transmitted, how it infects and affects humans, and how to control, treat and prevent it. This article briefly outlines how far we have come and proposes some options to better prepare for the next pandemic.
Green inhalers: reducing the carbon footprint of asthma care.
Wilkinson AJK, Smith LE, Woodcock A
Curr Opin Pulm Med · 2026 May · PMID 41670025 · Publisher ↗
PURPOSE OF REVIEW: The respiratory community faces an urgent need to reduce the environmental impact of care as the wider climate crisis threatens to worsen airways disease worldwide. Inhalers contribute a disproportiona...
PURPOSE OF REVIEW: The respiratory community faces an urgent need to reduce the environmental impact of care as the wider climate crisis threatens to worsen airways disease worldwide. Inhalers contribute a disproportionate share of healthcare emissions because of the hydrofluorocarbon (HFC) propellants in pressurized metered-dose inhalers (pMDIs). We already have effective, low-carbon, per- and polyfluoroalkyl substances (non-PFAS) options; particularly dry-powder inhalers (DPIs). This review summarizes recent developments in propellant technology and evidence on optimizing asthma care to improve outcomes while lowering emissions. RECENT FINDINGS: Life-cycle studies confirm that pMDI emissions are dominated by propellant released during use, whereas DPIs have far lower footprints. New global warming potential (low-GWP) propellants are in advanced development, and the first inhaler using HFO-1234ze(E) has recently been licensed in the UK. Emerging clinical and prescribing data show that optimized therapy, particularly strategies that incorporate low-carbon inhalers, can reduce short-acting beta-agonist (SABA) over-reliance, exacerbations, and per-patient emissions. Guideline-driven, health-system approaches using prescribing data and formulary design can accelerate sustainable, evidence-based inhaler use. SUMMARY: The most immediate path to reducing inhaler-related emissions is to optimize asthma care while prioritizing low-carbon devices where appropriate. As low-GWP pMDIs enter the market, careful planning will be needed to ensure reliable, affordable access to pMDIs is maintained or improved globally, particularly in low- and middle-income countries.
Corticosteroid stewardship in asthma: from individual prescribers to system-level change.
Gallub V, Rogers L, Kim B
Curr Opin Pulm Med · 2026 May · PMID 41664503 · Publisher ↗
PURPOSE OF REVIEW: In this review, we discuss the under-recognition of harms associated with corticosteroid overuse in asthma and highlight the concept of corticosteroid stewardship as an approach to address these harms....
PURPOSE OF REVIEW: In this review, we discuss the under-recognition of harms associated with corticosteroid overuse in asthma and highlight the concept of corticosteroid stewardship as an approach to address these harms. RECENT FINDINGS: Adverse health effects of chronic systemic steroids to treat asthma are well known in the medical community. There is less familiarity with recent data showing similar harms from repeated short courses of systemic corticosteroids (SCS) to treat asthma flares and long-term use of high dose inhaled corticosteroids (ICS). In this review, we summarize recent advances in our knowledge of adverse effects of corticosteroid overuse in asthma, highlight recent calls for corticosteroids stewardship in asthma care, and describe effective systems-based strategies used to reduce corticosteroid overuse in asthma. SUMMARY: Those involved in primary care, acute care, and specialty care of asthma may use this review for an updated understanding of corticosteroid associated harms, and as a guide to both individual practitioner and health systems-based approaches to corticosteroid stewardship.
Improving equity of access/transparency in organ allocation.
Krynychka K, Hartwig MG
Curr Opin Pulm Med · 2026 Jul · PMID 41664501 · Publisher ↗
PURPOSE OF REVIEW: Persistent inequities in lung transplant access arise from biologic constraints, geographic variation, and system-level practices that are not fully addressed by urgency-based allocation alone. The rec...
PURPOSE OF REVIEW: Persistent inequities in lung transplant access arise from biologic constraints, geographic variation, and system-level practices that are not fully addressed by urgency-based allocation alone. The recent implementation of continuous distribution and the Composite Allocation Score (CAS) represent a major policy shift intended to improve fairness and transparency in lung allocation. This review examines whether early evidence supports these goals and identifies remaining challenges. RECENT FINDINGS: Early national and multicenter analyses demonstrate increased transplant rates and reduced waitlist mortality under CAS without compromise in short-term posttransplant survival. Continuous geographic scoring and biologic disadvantage adjustments appear to improve access for short-statured candidates, women, and some sensitized patients. However, disparities persist for blood group O recipients, highly sensitized candidates, and patients listed at centers with conservative acceptance practices. Increased travel distance and rising allocation out of sequence (AOOS) highlight emerging transparency and logistical concerns. SUMMARY: Continuous distribution represents a meaningful advance in equity and transparency in lung allocation, but allocation reform alone cannot eliminate disparities arising from biologic limitation, geographic variation, or center-level practices. Ongoing monitoring, policy refinement, and system-wide standardization are essential to ensure equitable and ethical use of donor lungs.
GLP-1 receptor agonists in asthma: targeting metabolic-inflammatory crossroads.
O'Brien H, Franciosi AN, Butler MW
Curr Opin Pulm Med · 2026 May · PMID 41664500 · Publisher ↗
PURPOSE OF REVIEW: The application of GLP-1 receptor agonists as metabolic modulators is one the most exciting and advancing areas in medicine today. Early studies suggest a positive signal in asthma care in both obese a...
PURPOSE OF REVIEW: The application of GLP-1 receptor agonists as metabolic modulators is one the most exciting and advancing areas in medicine today. Early studies suggest a positive signal in asthma care in both obese and nonobese patients highlighting their multimodal utility across multiple disease phenotypes. RECENT FINDINGS: Asthmatic patients living with obesity are more likely to experience poor disease control, higher exacerbation rates and poor response to conventional asthma therapies. While weight loss interventions have repeatedly shown benefits in these patients, recent studies demonstrate that modulating insulin resistance may lead to improvement of asthma control, independent of weight. Recent translational/mechanistic/observational studies and meta-analyses provide a basis for pursuing GLP1RAs as putative asthma add-on therapies. This represents a novel area of treatment at the overlap between the inflammatory and metabolic nexus, potentially leading to better outcomes in uncontrolled asthma. SUMMARY: GLP-1RAs are receiving attention as potentially exciting therapies for treatment of asthma patients with comorbid obesity and/or diabetes mellitus; however, the exact mechanisms underpinning their utility in these cohorts are poorly understood. Further randomised controlled and pragmatic trials are needed to define their potential benefits/harms, mechanisms of action and where GLP1RAs might fit into existing treatment pathways for uncontrolled asthma.
Improving lung cancer screening diagnostic efficiency.
Caruso CR, Kim RY
Curr Opin Pulm Med · 2026 Jul · PMID 41645520 · Full text
PURPOSE OF REVIEW: We discuss opportunities to improve lung cancer screening (LCS) diagnostic efficiency, which necessitates simultaneous focus on both diagnosis of early-stage lung cancer and reduction of diagnostic err...
PURPOSE OF REVIEW: We discuss opportunities to improve lung cancer screening (LCS) diagnostic efficiency, which necessitates simultaneous focus on both diagnosis of early-stage lung cancer and reduction of diagnostic errors during diagnostic evaluation. RECENT FINDINGS: Recent efforts have focused on three distinct targets for improving LCS diagnostic efficiency: Eligibility and uptake, Adherence to annual screening, and Diagnostic evaluation of concerning findings. There has been ongoing debate regarding who should be screened and how to consider lung cancer risk factors, even as LCS uptake remains suboptimal. LCS annual adherence has emerged as an important quality metric, as it is associated with increased early-stage lung cancer detection. Finally, optimization of the diagnostic pathway once concerning findings are identified via LCS is necessary to minimize exposing those without cancer to the harms of invasive diagnostic testing. Efforts to improve pulmonary nodule risk assessment, the nonmalignant resection rate, and lung cancer overdiagnosis will be crucial. SUMMARY: Improving LCS diagnostic efficiency requires a careful balance between prioritizing lung cancer sensitivity (i.e., ability to diagnose early-stage lung cancers) and avoiding both false negatives (i.e., failure to diagnose an early-stage lung cancer) and false positives (i.e., unnecessary performance of invasive testing for benign lesions).
Factors influencing long-term outcomes in lung transplantation: effective monitoring and comprehensive intervention.
Takada J, Kawashima M, Sato M
Curr Opin Pulm Med · 2026 Jul · PMID 41640234 · Publisher ↗
PURPOSE OF REVIEW: Achieving long-term survival after lung transplantation remains a major challenge. Outcome determinants have expanded beyond pathophysiology to include quality of life and patient-reported outcomes. Th...
PURPOSE OF REVIEW: Achieving long-term survival after lung transplantation remains a major challenge. Outcome determinants have expanded beyond pathophysiology to include quality of life and patient-reported outcomes. This review summarizes key prognostic factors associated with outcomes and suggests integrated strategies to improve them. RECENT FINDINGS: The primary determinants of long-term survival are chronic lung allograft dysfunction (CLAD), infection, and malignancy. Various agents have been investigated for preventing and treating CLAD. Beyond these, managing comorbidities such as renal failure, metabolic disorders, and gastrointestinal dysfunction is crucial. Furthermore, patient-reported outcomes involving both physical and psychosocial aspects (e.g., frailty and sleep disturbance) have emerged as vital prognostic markers. To manage these multifaceted risks, real-time data pipelines (e.g., the Quality in Lung Transplant Initiative) and remote tools including home spirometry facilitate early detection of graft dysfunction. Multidisciplinary interventions, including rehabilitation, adherence support, and artificial intelligence-driven technologies, have shown promise in improving outcomes. SUMMARY: Improving long-term outcomes in lung transplantation requires a comprehensive approach that extends beyond traditional CLAD management. Structured, multicomponent programs integrating data-driven surveillance with multidisciplinary care provide a robust model for early detection and intervention for graft failure and comorbidities, ultimately prolonging survival and quality of life.
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