Curr Opin Pulm Med [JOURNAL]
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200 papers
Considering candidates: modifiable and nonmodifiable risk factors for lung transplantation.
Maheshwari JA, Leard LE
Curr Opin Pulm Med · 2025 Jul · PMID 40326440 · Publisher ↗
PURPOSE OF REVIEW: Evaluation of a candidate's risk profile for lung transplant includes understanding which patient factors can be addressed to minimize transplant risk. Some risk factors can be modified, while others c...
PURPOSE OF REVIEW: Evaluation of a candidate's risk profile for lung transplant includes understanding which patient factors can be addressed to minimize transplant risk. Some risk factors can be modified, while others cannot. This review explores current understanding of modifiable and nonmodifiable risk factors for lung transplantation. RECENT FINDINGS: Several risk factors for lung transplant can be resolved entirely, thereby minimizing a candidate's transplant risk. Some features cannot be eliminated, though can be optimized to minimize risk. Others cannot be altered and inherently bring risk to transplant, while a subset of nonmodifiable risk factors are considered absolute barriers to transplant. SUMMARY: Robust research and novel therapies have led to increased ability to modify certain risk factors and thus decrease lung transplant risk. Further studies are needed to better understand how to estimate risk profiles when assessing candidacy and timing for lung transplant.
Artificial intelligence applications for the diagnosis of pulmonary nodules.
Ost DE
Curr Opin Pulm Med · 2025 Jul · PMID 40326426 · Publisher ↗
PURPOSE OF REVIEW: This review evaluates the role of artificial intelligence (AI) in diagnosing solitary pulmonary nodules (SPNs), focusing on clinical applications and limitations in pulmonary medicine. It explores AI's...
PURPOSE OF REVIEW: This review evaluates the role of artificial intelligence (AI) in diagnosing solitary pulmonary nodules (SPNs), focusing on clinical applications and limitations in pulmonary medicine. It explores AI's utility in imaging and blood/tissue-based diagnostics, emphasizing practical challenges over technical details of deep learning methods. RECENT FINDINGS: AI enhances computed tomography (CT)-based computer-aided diagnosis (CAD) through steps like nodule detection, false positive reduction, segmentation, and classification, leveraging convolutional neural networks and machine learning. Segmentation achieves Dice similarity coefficients of 0.70-0.92, while malignancy classification yields areas under the curve of 0.86-0.97. AI-driven blood tests, incorporating RNA sequencing and clinical data, report AUCs up to 0.907 for distinguishing benign from malignant nodules. However, most models lack prospective, multiinstitutional validation, risking overfitting and limited generalizability. The "black box" nature of AI, coupled with overlapping inputs (e.g., nodule size, smoking history) with physician assessments, complicates integration into clinical workflows and precludes standard Bayesian analysis. SUMMARY: AI shows promise for SPN diagnosis but requires rigorous validation in diverse populations and better clinician training for effective use. Rather than replacing judgment, AI should serve as a second opinion, with its reported performance metrics understood as study-specific, not directly applicable at the bedside due to double-counting issues.
Infections and lung transplantation: key considerations for eligibility, management, and posttransplant care.
Huang J, Friedman-Moraco R, Pouch S
Curr Opin Pulm Med · 2025 Jul · PMID 40314095 · Publisher ↗
PURPOSE OF REVIEW: Lung transplantation is a critical and evolving therapy for patients with end-stage lung disease. As the need for lung transplantation increases, careful candidate selection is vital to maximizing outc...
PURPOSE OF REVIEW: Lung transplantation is a critical and evolving therapy for patients with end-stage lung disease. As the need for lung transplantation increases, careful candidate selection is vital to maximizing outcomes and ensuring appropriate organ allocation. A key challenge in lung transplant candidates is the colonization or infection of the lungs by environmental and upper airway pathogens. These lung pathogens, along with other chronic infections, can lead to posttransplant complications with high mortality and an increased risk of graft failure. RECENT FINDINGS: Major infectious considerations for lung transplantation include colonization or infection by multidrug-resistant bacteria (including Burkholderia cepacia complex), nontuberculous mycobacteria, molds, and chronic viral infections. By recognizing the epidemiology, diagnosis, and management of these infections in the peri-transplant period, transplant providers can better mitigate infectious risks and improve transplant success. Similarly, advancements in diagnostics and therapeutics offer novel approaches to managing previously challenging infections. SUMMARY: As experience grows in treating these difficult infectious syndromes, more candidates are becoming eligible for transplantation. A thorough understanding of infectious considerations in lung transplant candidates is essential for improving candidate selection, reducing posttransplant complications, and expanding transplant eligibility.
Timing of lung transplant evaluation: considerations, barriers and alternatives.
van der Ploeg EA, Hylkema TH, Gan CT
Curr Opin Pulm Med · 2025 Jul · PMID 40276963 · Full text
PURPOSE OF REVIEW: Over the past decade, increased knowledge has contributed to improved medical and technical treatments across the spectrum of respiratory diseases. As a result, timing for transplant evaluation might b...
PURPOSE OF REVIEW: Over the past decade, increased knowledge has contributed to improved medical and technical treatments across the spectrum of respiratory diseases. As a result, timing for transplant evaluation might be more challenging. In this review, the focus is on timing of lung transplant evaluation of patients from the main respiratory diseases referred. Disease-specific predictors of survival in relation to timing of transplant evaluation and alternative treatments will be reviewed. RECENT FINDINGS: Treatment options have evolved for respiratory diseases like chronic obstructive pulmonary disease, pulmonary fibrosis, cystic fibrosis and pulmonary arterial hypertension. These treatments have led to improved quality of life, exercise tolerance, lung function and outcome. However, the effect of these alternative treatments on transplant candidacy and knowledge on timing of lung transplant evaluation are lacking. SUMMARY: This article reviews the current best evidence to guide clinicians regarding the optimum timing for transplant referral and highlights considerations to optimize transplant candidacy and outcomes.
Emerging therapies and current standards in pulmonary carcinoid management.
Aronowitz DI, Hyman K
Curr Opin Pulm Med · 2025 Jul · PMID 40265677 · Publisher ↗
PURPOSE OF REVIEW: Relative to other lung tumors, pulmonary carcinoid tumors are rare and have unique histopathological and clinical features. The purpose of this review is to summarize the presentation and management of...
PURPOSE OF REVIEW: Relative to other lung tumors, pulmonary carcinoid tumors are rare and have unique histopathological and clinical features. The purpose of this review is to summarize the presentation and management of pulmonary carcinoid tumors, with a particular focus on recent clinical trials in the management of advanced and metastatic disease. RECENT FINDINGS: Surgical resection remains a central tenet in the management of pulmonary carcinoid tumors that are localized and even those that have locoregional spread. However, in recent years, the treatment of pulmonary carcinoid has expanded to include several systemic hormonal and cytotoxic therapies as well as radiation and endobronchial strategies. The decision to initiate any of these therapies as either primary or adjuvant treatment after resection depends upon several factors including tumor stage, disease burden, patient's functional status, and whether they will tolerate surgery. SUMMARY: The treatment of pulmonary carcinoid tumors has expanded beyond just surgical resection. Novel regimens of systemic hormonal and cytotoxic therapies as well as radiation and endobronchial intervention should be customized for each patient by a multidisciplinary team of surgeons, medical and radiation oncologists, pulmonologists, and pathologists.
Stereotactic body radiation therapy in the management of lung neoplasms: is it ready for prime time?
Eustace N, Amini A, Malhotra J … +3 more , Higgins KA, Williams TM, Lee P
Curr Opin Pulm Med · 2025 Jul · PMID 40265515 · Publisher ↗
PURPOSE OF REVIEW: Advances in radiation delivery have expanded the scope of stereotactic body radiation therapy (SBRT) in lung cancer treatment, as it offers better local control, shorter treatments, and enhanced immuno...
PURPOSE OF REVIEW: Advances in radiation delivery have expanded the scope of stereotactic body radiation therapy (SBRT) in lung cancer treatment, as it offers better local control, shorter treatments, and enhanced immunostimulation. This review summarizes recent literature regarding SBRT's role in nonoperable and operable early-stage, locally advanced, central, and oligometastatic nonsmall cell lung cancer (NSCLC), and its mixed results with immunotherapy. RECENT FINDINGS: Recent studies demonstrate SBRT achieves excellent local control in inoperable early-stage NSCLC and is being explored as an alternative to surgery for operable cases. Additionally, SBRT can be done safely in central tumors if strict dose limits to normal structures are observed. SBRT shows promise in locally advanced disease, as consolidative local therapy for oligoprogressive and oligometastatic disease and in combination with immune checkpoint inhibitors. Advances in adaptive radiation therapy and novel fractionation schedules, including ultra-hypofractionation and personalized approaches, further refine SBRT's role in lung cancer management, with more practice changing clinical trials on the horizon. SUMMARY: SBRT provides durable and well tolerated treatment for patients with localized and metastatic lung cancer. With ongoing trials exploring its synergy with immunotherapy and its applicability in operable patients and large tumors, SBRT is poised to play an even greater role in personalized lung cancer treatment.
Management of pharmacotherapy in lung transplant candidates.
Rudzik KN, Lyster H
Curr Opin Pulm Med · 2025 Jul · PMID 40265512 · Publisher ↗
PURPOSE OF REVIEW: Lung transplantation is a common treatment for end-stage lung disease (ESLD). Patients present to lung transplantation evaluation on various medications that could impact their candidacy and posttransp...
PURPOSE OF REVIEW: Lung transplantation is a common treatment for end-stage lung disease (ESLD). Patients present to lung transplantation evaluation on various medications that could impact their candidacy and posttransplant course. In this review, we will discuss pretransplant optimization of pharmacotherapy to minimize complications while waiting for transplant and increase posttransplant success. We will also discuss important considerations for posttransplant immunosuppression, antimicrobial prophylaxis, and complex drug interactions. RECENT FINDINGS: Prior to lung transplantation, several medications should be optimized to promote posttransplant success including minimization of corticosteroids, opioids, and benzodiazepines. Lung transplantation candidates should be up to date on vaccinations. Most medications for ESLD are well tolerated to continue up until the point of transplant including antifibrotics, CFTR modulators, and pulmonary vasodilators. Mammalian target of rapamycin inhibitors and other immunosuppressants may need to be stopped or minimized before lung transplantation to minimize posttransplant infection and would healing complications. Medications that increase risk of posttransplant bleeding, thrombosis, or aspiration should be stopped prior to listing. SUMMARY: In this article, we discuss management of pharmacotherapy for lung transplantation candidates to minimize posttransplant complications. Changes in medications for ESLD should be done cautiously to prevent worsening of native disease while waiting for lung transplantation.
Immune checkpoint inhibitor-associated pneumonitis: focus on diagnosis and underlying mechanisms.
Khoury M, Faiz SA, Sheshadri A
Curr Opin Pulm Med · 2025 Jul · PMID 40265506 · Publisher ↗
PURPOSE OF REVIEW: This review aims to provide an updated overview of the diagnosis, risk factors, and treatment strategies for immune checkpoint inhibitor (ICI) pneumonitis, with a particular emphasis on its underlying...
PURPOSE OF REVIEW: This review aims to provide an updated overview of the diagnosis, risk factors, and treatment strategies for immune checkpoint inhibitor (ICI) pneumonitis, with a particular emphasis on its underlying pathophysiology. RECENT FINDINGS: Recent advances, such as single-cell RNA sequencing of bronchoalveolar lavage fluid and the identification of biomarkers, including autoantibodies, are enhancing our understanding of ICI-related pneumonitis. These findings suggest that both cell-mediated and humoral mechanisms contribute to the pathophysiology of the condition. SUMMARY: Pneumonitis can significantly limit the efficacy of life-saving cancer treatments, such as ICIs. Although corticosteroids are the first-line treatment according to guidelines, steroid-refractory pneumonitis remains common and is associated with high mortality. Emerging data is providing a more detailed understanding of the dysregulated immune response responsible for pneumonitis, which may guide the development of targeted therapies and direct future research efforts.
The ABC of transplant: ALAD, BLAD, and CLAD: definition and significance.
Verleden GM, Bos S
Curr Opin Pulm Med · 2025 Jul · PMID 40165763 · Publisher ↗
PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) is a recognized complication after lung transplantation, with a clear definition, although some pitfalls in phenotyping still exist. Recently, new terminologie...
PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) is a recognized complication after lung transplantation, with a clear definition, although some pitfalls in phenotyping still exist. Recently, new terminologies, such as acute lung allograft dysfunction (ALAD) and baseline lung allograft dysfunction (BLAD) were introduced, but their definitions and real significance are not yet fully established. RECENT FINDINGS: Based on the existing literature and ongoing discussions within two expert groups of the Advanced Lung Failure & Transplantation Interdisciplinary Network (ALFTx IDN) of the International Society for Heart and Lung Transplantation (ISHLT), we will describe current definitions, prevalence and outcome of these rather new entities, keeping in mind that a lot of uncertainties still exist. SUMMARY: ALAD and BLAD will be defined, and the currently accepted outcome of these conditions will be summarized. Existing pitfalls in the phenotyping of CLAD will also be discussed.
Advancing lung transplantation through machine learning and artificial intelligence.
Ronen L, Keshavjee S, Sage AT
Curr Opin Pulm Med · 2025 Jul · PMID 40152900 · Full text
PURPOSE OF REVIEW: To explore the current applications of artificial intelligence and machine learning in lung transplantation, including outcome prediction, drug dosing, and the potential future uses and risks as the te...
PURPOSE OF REVIEW: To explore the current applications of artificial intelligence and machine learning in lung transplantation, including outcome prediction, drug dosing, and the potential future uses and risks as the technology continues to evolve. RECENT FINDINGS: While the use of artificial intelligence (AI) and machine learning (ML) in lung transplantation is relatively new, several groups have developed models to predict short-term outcomes, such as primary graft dysfunction and time-to-extubation, as well as long-term outcomes related to survival and chronic lung allograft dysfunction. Additionally, drug dosing models for Tacrolimus levels have been designed, demonstrating proof of concept for modelling treatment as a time-series problem. SUMMARY: The integration of ML models with clinical decision-making has shown promise in improving post-transplant survival and optimizing donor lung utilization. As technology advances, the field will continue to evolve, with enhanced datasets supporting more sophisticated ML models, particularly through real-time monitoring of biological, biochemical, and physiological data.
Telomeropathy: pretransplant and posttransplant considerations for clinicians.
Mackintosh JA
Curr Opin Pulm Med · 2025 Jul · PMID 40145203 · Publisher ↗
PURPOSE OF REVIEW: This review examines the current understanding of telomere biology disorders (TBDs) in advanced lung disease, with particular focus on their implications for lung transplantation outcomes and managemen...
PURPOSE OF REVIEW: This review examines the current understanding of telomere biology disorders (TBDs) in advanced lung disease, with particular focus on their implications for lung transplantation outcomes and management. RECENT FINDINGS: Recent studies have revealed that TBDs are enriched in lung transplant populations, with many idiopathic pulmonary fibrosis transplant recipients having short telomeres and/or carrying variants in telomere-related genes. While survival outcomes remain debated, recipients with short telomeres consistently show increased susceptibility to cytopenias, cytomegalovirus (CMV) infection, and may require modified immunosuppression regimens. New evidence suggests potential protection against acute cellular rejection in some cases, and novel approaches using letermovir for CMV prophylaxis show promise in managing these complex patients. SUMMARY: Management of lung transplant recipients with TBDs requires careful consideration of multiorgan manifestations and individualized management strategies. A multidisciplinary approach incorporating genetics, haematology, and hepatology expertise is increasingly essential for optimal outcomes in this unique population.
Non-T2 asthma.
Duffus EK, Holguin F, Rastogi D
Curr Opin Pulm Med · 2025 May · PMID 40125574 · Full text
PURPOSE OF REVIEW: This review provides a comprehensive overview of the non-T asthma phenotypes. Asthma is an umbrella term that defines a complex group of heterogenous airway disorders, which are broadly categorized int...
PURPOSE OF REVIEW: This review provides a comprehensive overview of the non-T asthma phenotypes. Asthma is an umbrella term that defines a complex group of heterogenous airway disorders, which are broadly categorized into predominantly T2 or non-T2 phenotypes depending on the presence and levels of airway and systemic biomarkers associated with a T2 inflammatory response. Individuals with predominant T2 asthma have greater numbers of peripheral blood eosinophils, exhaled nitric oxide and IgE. These patients have more atopy and earlier onset asthma. In contrast, the absence or low levels of these biomarkers define non-T2 asthma. This is a heterogenous group with a later onset of asthma that is also more commonly associated with obesity and with females. RECENT FINDINGS: This article summarizes new information regarding the plasticity that exists between T2 and non-T2 mechanisms, including their role in exacerbation-prone and nonexacerbating asthma, and many of the risk factors associated with the non-T2 phenotype, such as viral infections, ambient air pollution exposure, smoking, genetic and metabolic factors. It also provides new information on the immunological and metabolic mechanisms associated with non-T2 asthma. We also discuss how to manage this asthma phenotype and how treatment responses differ for these patients. SUMMARY: Non-T2 asthma defines a heterogenous group of asthma phenotypes. However, acknowledging that the absence of T2 biomarkers is influenced by several factors is important and can longitudinally change in relation to exacerbations, particularly in children.
Optimizing adherence to medication to improve outcomes in asthma.
Rackow P, Drennan A, Pinnock H … +1 more , Dima AL
Curr Opin Pulm Med · 2025 May · PMID 40105049 · Full text
PURPOSE OF REVIEW: Adherence to medication is essential for asthma control and reducing the risk of exacerbations. Research has accumulated in recent years on causes and consequences of adherence and effective interventi...
PURPOSE OF REVIEW: Adherence to medication is essential for asthma control and reducing the risk of exacerbations. Research has accumulated in recent years on causes and consequences of adherence and effective interventions. This review highlights current advances in adherence research and their potential for clinical practice. FINDINGS: Optimizing adherence to medication can be achieved through interventions that identify individual barriers and train the care team in offering tailored support. Digital technologies that facilitate remote monitoring, patient-provider communication and care coordination are increasingly being integrated into asthma care. SUMMARY: Adherence determinants reported cover individual, social and health service-related factors. Age and attitudes toward adherence are crucial determinants. Patients' and caregivers' mental health is relevant for adherence and clinical outcomes, highlighting the importance of integrating this aspect into holistic asthma management. Single-site care arrangements are beneficial for adherence. Tailoring adherence interventions to individual needs, using brief questionnaires to assess barriers and recommending evidence-based strategies to address them, have been found useful and feasible across care settings. Digital technologies such as smart inhaler systems and telemedicine-enhanced care have been shown to be effective in randomized controlled trials, yet implementation research highlights challenges to sustaining support on the long-term.
Mucosal-associated invariant T-cells in pulmonary pathophysiology.
Kamiki J, Gorgulho CM, Lérias JR … +1 more , Maeurer MJ
Curr Opin Pulm Med · 2025 May · PMID 40104908 · Full text
PURPOSE OF REVIEW: Mucosal-associated invariant T-cells (MAIT) have been associated with lung cancer and pulmonary infections. The treatment of patients with cancer or infections includes host-directed therapies (HDTs)....
PURPOSE OF REVIEW: Mucosal-associated invariant T-cells (MAIT) have been associated with lung cancer and pulmonary infections. The treatment of patients with cancer or infections includes host-directed therapies (HDTs). MAIT play a role in shaping the 'milieu interne' in cancer and infections and this review addresses the biology of MAIT in pulmonary pathophysiology. RECENT FINDINGS: MAIT represent an attractive target for therapy in pulmonary malignancies and infections. T-cells are often difficult to exploit therapeutically due to the diversity of both T-cell receptor (TCR) repertoire and its ligandome. MAIT-cells are restricted by the major histocompatibility complex class I-related gene protein (MR1) that presents nondefined tumor-associated targets, bacterial products, vitamin and drug derivates. Due to their plasticity in gene expression, MAIT are able to conversely switch from IFN-γ to IL-17 production. Both cytokines play a key role in protective immune responses in infections and malignancies. MAIT-derived production of interleukin (IL)-17/TGF-β shapes the tumor micro-environment (TME), including tissue re-modelling leading to pulmonary fibrosis and recruitment of neutrophils. MAIT contribute to the gut-lung axis associated with clinical improved responses of patients with cancer to checkpoint inhibition therapy. MAIT are at the crossroad of HDTs targeting malignant and infected cells. Clinical presentations of overt inflammation, protective immune responses and tissue re-modeling are reviewed along the balance between Th1, Th2, Th9, and Th17 responses associated with immune-suppression or protective immune responses in infections. SUMMARY: MAIT shape the TME in pulmonary malignancies and infections. Drugs targeting the TME and HDTs affect MAIT that can be explored to achieve improved clinical results while curbing overt tissue-damaging immune responses.
Type 2 inflammation, a common denominator in chronic airway disease?
Schedel M, Heimel V, Taube C
Curr Opin Pulm Med · 2025 May · PMID 40104899 · Publisher ↗
PURPOSE OF REVIEW: This review addresses the growing understanding that a specific subset of patients with a respiratory disease, including asthma, chronic obstructive pulmonary disease (COPD), or bronchiectasis may have...
PURPOSE OF REVIEW: This review addresses the growing understanding that a specific subset of patients with a respiratory disease, including asthma, chronic obstructive pulmonary disease (COPD), or bronchiectasis may have one thing in common: type 2 inflammation. In the era of personalized medicine, we need to refine clinical markers combined with molecular and cellular endotyping to improve patient outcomes. RECENT FINDINGS: Recent literature reveals that type 2 markers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), and immunglobulin E (IgE), can provide valuable insights into disease progression, exacerbation risk, and treatment response, but their stability remains to be investigated. Treating asthma and COPD patients with biologics to target IL-4/IL-13, IL-5, and alarmins have shown potential, although efficacy varied. In bronchiectasis, a subset of patients with type 2 inflammation may benefit from corticosteroid therapy, despite broader concerns regarding its use. SUMMARY: This underscores the importance of improved disease endotyping to better characterize patients who may benefit from targeted therapies. In clinical practice, personalized treatment based on inflammatory profiles has been shown to improve outcomes in heterogeneous lung diseases. Future research needs to focus on validating reliable biomarkers and optimizing clinical trial designs to advance therapeutic strategies in respiratory diseases.
Parasitic lung diseases.
Allen SH
Curr Opin Pulm Med · 2025 May · PMID 40062465 · Publisher ↗
PURPOSE OF REVIEW: Parasitic lung diseases occur because of transient migration of parasites in the lung or because of a subsequent immunologic reaction. The purpose of this review is to scan for any recent developments...
PURPOSE OF REVIEW: Parasitic lung diseases occur because of transient migration of parasites in the lung or because of a subsequent immunologic reaction. The purpose of this review is to scan for any recent developments in the epidemiology, diagnostics and treatment of these exotic diseases. RECENT FINDINGS: Disease is mostly seen in endemic countries, but with international travel, globalization and mass migration, together with their late presentations, these diseases can present worldwide, often mimicking other conditions. The expansion of immunosuppressive and chemotherapeutic agents has led to some increase in the susceptibility to parasitic infection and parasitic hyper-infection syndromes. SUMMARY: In this review, we consider the principle pulmonary parasites of medical significance, their natural history, clinical and radiological features, and their management.
Recent advances in asthma mucus biology and emerging treatment strategies.
Fedosenko S, Venegas Garrido C, Nair P
Curr Opin Pulm Med · 2025 May · PMID 40047213 · Publisher ↗
PURPOSE OF REVIEW: To describe the recent advances in the pathobiology and treatment of mucus hypersecretion in asthma, a critical factor contributing to airway obstruction, inflammation, and impaired lung function. RECE...
PURPOSE OF REVIEW: To describe the recent advances in the pathobiology and treatment of mucus hypersecretion in asthma, a critical factor contributing to airway obstruction, inflammation, and impaired lung function. RECENT FINDINGS: Significant progress has been made in understanding how mucin protein regulation, mucus viscosity, and adhesion are affected by cytokine-driven inflammation, especially interleukin-13, and defects in ion transport mechanisms. Advances in imaging techniques, such as multidetector computed tomography (MDCT) and hyperpolarized gas MRI, allow for a more precise assessment of mucus plugging and associated ventilation defects. Emerging therapies, including biologicals targeting type-2 (T2) inflammation, and novel mucolytics aimed at modifying mucus properties and secretion, offer promising effects in reducing mucus in severe asthmatics. SUMMARY: The growing understanding of mucus biology and the development of advanced imaging and therapeutic strategies could significantly improve the management of mucus-related complications in asthma. By targeting mucus characteristics, these findings support future approaches to reduce airway obstruction, enhance lung function, and improve clinical outcomes in patients with severe asthma. A deeper understanding of the glycobiology of mucus is critical to develop new therapies.
Comorbidities and multimorbidity in asthma.
Maselli DJ, Sherratt J, Adams SG
Curr Opin Pulm Med · 2025 May · PMID 40047208 · Publisher ↗
PURPOSE OF REVIEW: To describe the associations between asthma and relevant comorbidities, and appraise the latest evidence on the management strategies of asthmatics with comorbid conditions. RECENT FINDINGS: Conditions...
PURPOSE OF REVIEW: To describe the associations between asthma and relevant comorbidities, and appraise the latest evidence on the management strategies of asthmatics with comorbid conditions. RECENT FINDINGS: Conditions such as allergic rhinitis, chronic rhinosinusitis with and without nasal polyps, gastroesophageal reflux disease, obesity, chronic obstructive pulmonary disease, bronchiectasis, anxiety and depression have been linked to worse outcomes in asthma. Recognition and treatment of these conditions is important in asthma, particularly in those with uncontrolled or severe asthma. Biologics for asthma have been effective in those with chronic rhinosinusitis with nasal polyps and chronic obstructive pulmonary disease (COPD), with emerging evidence in bronchiectasis. Weight loss programs with diet and exercise improve asthma control. Anxiety and depression are often unrecognized in patients with asthma. SUMMARY: Comorbid conditions have been recognized as important factors in the diagnosis and treatment of asthma, particularly in patients who have severe disease and remain uncontrolled. Comorbidities in asthma are correlated with poor quality of life and asthma control, increased healthcare utilization and their treatment is associated with improved outcomes.
Recent evidence for stepping down severe asthma therapies.
Merrell E, Khurana S
Curr Opin Pulm Med · 2025 May · PMID 40018811 · Full text
PURPOSE OF REVIEW: Biologics have proven safe and effective for severe asthma. Their introduction has offered hope for patients and prescribers with a growing list of novel medications and indications. While 'step-up' in...
PURPOSE OF REVIEW: Biologics have proven safe and effective for severe asthma. Their introduction has offered hope for patients and prescribers with a growing list of novel medications and indications. While 'step-up' indications for biologic initiation are well described in guidelines, 'step-down' strategy remains poorly understood and thus guidance is limited. In this opinion article we aim to focus on recent practice changing evidence for stepping-down severe asthma management, tools for the assessment of biologic efficacy, propose a framework for the step-down of biologic and nonbiologic therapies and suggest topics of interest for future research. RECENT FINDINGS: Clinical tools have been developed to aid in assessing biologic response. Some patients experience marked improvement and may enter a period of clinical remission or even complete remission. Following positive response, add-on therapy may safely be approached for taper or withdrawal. SUMMARY: There is limited consensus but growing evidence for stepping-down therapies in patients who achieve clinical response and/or remission after biologic initiation. Further structured guidance would benefit clinicians who face clinical uncertainty when deciding to step-down therapy in patients with well controlled asthma.
Infection prevention and control of epidemic-prone acute respiratory infections in healthcare setting.
Simniceanu A, Satta G
Curr Opin Pulm Med · 2025 May · PMID 40013505 · Publisher ↗
PURPOSE OF REVIEW: The recent COVID-19 pandemic sparked discussions and highlighted significant gaps on the most appropriate infection prevention and control (IPC) measures when dealing with acute respiratory infections...
PURPOSE OF REVIEW: The recent COVID-19 pandemic sparked discussions and highlighted significant gaps on the most appropriate infection prevention and control (IPC) measures when dealing with acute respiratory infections (ARIs). This narrative review aims to provide an overview of the existing international and national guidelines on the IPC measures to control epidemic and pandemic-prone ARIs in healthcare settings. RECENT FINDINGS: The WHO has recently produced a report proposing an updated terminology for respiratory pathogens. One of the key outcomes of this consultation was the adoption of the term 'infectious respiratory particles' (IRPs). According to the report, IRPs are defined as infectious particles that can be expired from an infected person through activities like breathing, talking, singing, coughing, sneezing, or even spitting. Most notably, there is no longer the clear and traditional distinction between droplet and aerosol based on the cut-off of particle size, but rather a continuum of particle sizes of IRPs. SUMMARY: Among other recommendations, all international guidelines place emphasis on the use of standard and transmission-based precautions when dealing with respiratory viruses. It is important to assess how the new proposed terminology for respiratory pathogens may affect the current existing IPC measures.
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