Curr Opin Pulm Med [JOURNAL]
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200 papers
Whole lung lavage: considerations from the anesthesiology perspective.
Sikachi R, Anders M
Curr Opin Pulm Med · 2025 Jan · PMID 39513386 · Publisher ↗
PURPOSE OF REVIEW: Whole lung lavage (WLL) remains the standard treatment for pulmonary alveolar proteinosis (PAP). The procedure involves meticulous preparation, including a multidisciplinary team and appropriate facili...
PURPOSE OF REVIEW: Whole lung lavage (WLL) remains the standard treatment for pulmonary alveolar proteinosis (PAP). The procedure involves meticulous preparation, including a multidisciplinary team and appropriate facilities, to ensure patient safety and procedural success. Effective anesthesia management is essential to allow for successful completion of the procedure and prevent complications. RECENT FINDINGS: Effective anesthesia management, including total intravenous anesthesia (TIVA) and careful intraoperative monitoring, is essential to prevent complications such as hypoxemia and fluid overload. Proper airway control with a double-lumen tube, careful positioning, and continuous monitoring during the lavage phase are key to minimizing risks. Challenges such as fluid spillage and ventilation-perfusion mismatch must be managed proactively with techniques such as fiberoptic bronchoscopy and recruitment maneuvers. In cases of severe hypoxemia, advanced options like extra-corporeal membrane oxygenation (ECMO) or sequential lavage may be required. SUMMARY: WLL is a pivotal treatment for PAP, offering significant relief and improvement for many patients despite the challenges in standardizing the procedure due to the rare nature of the condition. Involvement of a multidisciplinary team involving pulmonologist, anesthesiologist, critical care personnel, operating room personnel and in some cases and centers, cardiothoracic surgeon and perfusionist is critical to the success of the procedure.
Multidisciplinary care in nonmalignant central airway obstruction.
Murgu S, Urrutia-Royo B, Ntiamoah P … +1 more , Dutau H
Curr Opin Pulm Med · 2025 Jan · PMID 39498602 · Publisher ↗
PURPOSE OF REVIEW: The management of histologically benign central airway obstruction (CAO) is complex. Published studies have focused on the diagnostic approaches and therapeutic options provided by specific specialties...
PURPOSE OF REVIEW: The management of histologically benign central airway obstruction (CAO) is complex. Published studies have focused on the diagnostic approaches and therapeutic options provided by specific specialties, but there has been no focus on multidisciplinary management of this disease. Our objective is to review the current diagnostic and therapeutic modalities available for managing nonmalignant CAO from a multidisciplinary perspective involving otolaryngology, thoracic surgery and interventional bronchoscopists. RECENT FINDINGS: For benign airway strictures, management is via medical and endoscopic therapy with surgical resection reserved for complex and recurrent stenoses. There is evidence and growing interest in intralesional corticosteroid injection in treating inflammation and potentially preventing recurrence. Airway specialists from distinct disciplines use different laser types, dilating balloons and anesthesia methods to manage benign CAO. Recent studies have demonstrated substantial improvements in patient breathlessness and quality of life following therapeutic airway interventions, highlighting the evolving landscape in this cross-disciplinary field. SUMMARY: Nonmalignant CAO, arising from various mechanical, inflammatory, and infectious etiologies, poses significant morbidity and mortality risks. Current treatments include endoscopic resection, dilation, stent placement, and surgical resection which are selected based on lesion's complexity, extent, operability and patient's symptoms and goals. A multimodal and multidisciplinary approach to patient care could offer the best outcomes.
The bronchiectasis microbiome: current understanding and treatment implications.
Narayana JK, Mac Aogáin M, Hansbro PM … +1 more , Chotirmall SH
Curr Opin Pulm Med · 2025 Mar · PMID 39492755 · Publisher ↗
PURPOSE OF REVIEW: Advances in DNA sequencing and analysis of the respiratory microbiome highlight its close association with bronchiectasis phenotypes, revealing fresh opportunities for diagnosis, stratification, and pe...
PURPOSE OF REVIEW: Advances in DNA sequencing and analysis of the respiratory microbiome highlight its close association with bronchiectasis phenotypes, revealing fresh opportunities for diagnosis, stratification, and personalized clinical intervention. An under-recognized condition, bronchiectasis is increasingly the subject of recent large-scale, multicentre, and longitudinal clinical studies including detailed analysis of the microbiome. In this review, we summarize recent progress in our understanding of the bronchiectasis microbiome within the context of its potential use in treatment decisions. RECENT FINDINGS: Diverse microbiome profiles exist in bronchiectasis, in line with the established disease heterogeneity including treatment response. Classical microbiology has established Pseudomonas aeruginosa and Haemophilus influenza as two microbial markers of disease, while holistic microbiome analysis has uncovered important associations with less common bacterial taxa including commensal an/or pathobiont species, including the emerging role of the fungal mycobiome, virome, and interactome. Integration of airway microbiomes with other high-dimensional biological and clinical datasets holds significant promise to determining treatable traits and mechanisms of disease related to the microbiome. SUMMARY: The bronchiectasis microbiome is an emerging and key area of study with significant implications for understanding bronchiectasis, influencing treatment decisions and ultimately improving patient outcomes.
Rigid versus flexible bronchoscopy in interventional pulmonology: perspective from the master clinicians.
Aravena C, Mehta AC
Curr Opin Pulm Med · 2025 Jan · PMID 39492750 · Publisher ↗
PURPOSE OF REVIEW: The review explores the evolving roles and comparative effectiveness of rigid versus flexible bronchoscopy in interventional pulmonology. This topic is particularly timely due to recent technological a...
PURPOSE OF REVIEW: The review explores the evolving roles and comparative effectiveness of rigid versus flexible bronchoscopy in interventional pulmonology. This topic is particularly timely due to recent technological advancements and the growing body of literature highlighting the strengths and limitations of each technique. RECENT FINDINGS: Recent literature reveals significant advancements in rigid and flexible bronchoscopy, with studies comparing their efficacy, safety profiles, and clinical outcomes. Key themes include improved diagnostic and therapeutic capabilities, procedural innovations, and patient-centered outcomes. SUMMARY: While rigid and flexible bronchoscopies have distinct advantages, their complementary use can enhance patient care. Future research should focus on developing minimally invasive, high-precision bronchoscopic tools, comparative studies to inform evidence-based practice, exploring hybrid approaches that combine the strengths of both techniques, and enhancing patient-centered outcomes through improved procedural protocols, education, and technologies.
The evolving role of medical thoracoscopy on therapeutic management of pleural disease.
Fong C, Lee YCG, Maskell N … +1 more , Lee P
Curr Opin Pulm Med · 2025 Jan · PMID 39471097 · Publisher ↗
PURPOSE OF REVIEW: The use of medical thoracoscopy (MT) has gained widespread acceptance for the diagnosis and management of pleural disease. It is less invasive compared to video-assisted thoracoscopic surgery (VATS), c...
PURPOSE OF REVIEW: The use of medical thoracoscopy (MT) has gained widespread acceptance for the diagnosis and management of pleural disease. It is less invasive compared to video-assisted thoracoscopic surgery (VATS), can be performed in the endoscopy suite and in patients who are unfit to undergo general anaesthesia. It is safe, with high diagnostic yield, and enables pulmonologists to intervene therapeutically. RECENT FINDINGS: There have been several developments in this field, particularly for malignant pleural effusions (MPE). Specifically, we discuss further techniques that can be employed during MT to distinguish between benign and malignant pleural disease. There is also potential for combined thoracoscopic talc poudrage (TTP) and indwelling pleural catheter (IPC) insertion to shorten hospital stay. SUMMARY: Beyond MPE, we discuss the role of MT in patients with pneumothorax and pleural infection. We discuss the advantages and disadvantages of MT over traditional practices in a variety of conditions - diagnosis of exudative pleural effusions, prevention of recurrent MPE and pneumothoraces as well as treatment of pleural infections, so as to better aid physicians in selecting the optimum procedure for patients.
Pulmonary embolism work-up in chronic obstructive pulmonary disease exacerbations: what is the best strategy for clinicians?
Jiménez D, Bertoletti L, Bikdeli B
Curr Opin Pulm Med · 2025 Mar · PMID 39469884 · Publisher ↗
PURPOSE OF REVIEW: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural course of COPD, as they increase morbidity and mortality. Acute pulmonary embolism may mimic the...
PURPOSE OF REVIEW: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural course of COPD, as they increase morbidity and mortality. Acute pulmonary embolism may mimic the symptoms of COPD exacerbations. However, the exact prevalence of pulmonary embolism in unexplained exacerbations of COPD is unclear based on the current data. This review provides a practical approach to patients with COPD complaining of worsening respiratory symptoms. RECENT FINDINGS: A randomized clinical trial has shown that a routine pulmonary embolism diagnostic work-up does not improve care of patients with acute exacerbations of COPD. However, review of the recent literature suggests that a nonnegligible proportion of otherwise unexplained exacerbations of COPD may be caused by pulmonary embolism. To date, nevertheless, there are limited studies developing and validating clinical models that might aid in the identification of patients requiring additional tests for the diagnosis of pulmonary embolism. SUMMARY: Until new evidence becomes available, we believe that a routine diagnostic strategy for pulmonary embolism is not appropriate for patients with acute exacerbations of COPD. Recommendations for routine pulmonary embolism diagnostic work-up necessitate further development of prognostic models and conduct of clinical trials that assess important health outcomes.
Cryoprobe biopsy versus mechanical biopsies in pulmonary diagnostics.
Ueoka M, Ronaghi R, Khauli S … +1 more , Channick CL
Curr Opin Pulm Med · 2025 Jan · PMID 39412043 · Publisher ↗
PURPOSE OF REVIEW: Biopsy tools have been essential in improving the diagnostic accuracy of bronchoscopic procedures. Of these tools, cryobiopsy has emerged as a promising technique for diagnosing thoracic diseases. This...
PURPOSE OF REVIEW: Biopsy tools have been essential in improving the diagnostic accuracy of bronchoscopic procedures. Of these tools, cryobiopsy has emerged as a promising technique for diagnosing thoracic diseases. This review summarizes the existing data comparing cryobiopsies to other mechanical biopsy methods for sampling endobronchial, parenchymal, and mediastinal targets. RECENT FINDINGS: Initially adopted for managing airway stenoses, the use of cryoprobes has expanded to diagnosing endobronchial lesions, parenchymal opacities, and mediastinal lymph node pathologies. Studies have demonstrated that cryobiopsy offers a higher diagnostic yield than forceps biopsy alone. By leveraging the Joule-Thomson effect to freeze and collect larger tissue samples compared to traditional methods, cryobiopsy improves diagnostic accuracy and helps in better characterizing the nature of the lesions. While the risk of complications, such as pneumothorax and hemorrhage are comparable to, or higher than traditional biopsy methods, cryobiopsy's enhanced diagnostic capabilities make it a valuable tool in the assessment of pulmonary disease. SUMMARY: Compared with other mechanical biopsy techniques, cryoprobe biopsies significantly enhance the diagnostic yield for endobronchial lesions, interstitial lung disease, pulmonary nodules, and mediastinal lymph nodes.
Ergonomics in bronchoscopy.
Di Felice C, Alunilkummannil J, Holden V
Curr Opin Pulm Med · 2025 Jan · PMID 39412042 · Publisher ↗
PURPOSE OF REVIEW: This study examines ergonomic considerations in bronchoscopic procedures, surveying existing research, injury rates, contributing factors, and practical ergonomic controls. RECENT FINDINGS: The field o...
PURPOSE OF REVIEW: This study examines ergonomic considerations in bronchoscopic procedures, surveying existing research, injury rates, contributing factors, and practical ergonomic controls. RECENT FINDINGS: The field of ergonomics examines the relationship between workers and their workplace to enhance productivity and minimize injuries. Bronchoscopists may face ergonomic hazards due to extended periods of maintaining fixed positions, repetitive actions, and the design of both tools and procedure spaces. Studies on the ergonomics of bronchoscopy have revealed a wide range of musculoskeletal issues among practitioners. Those new to the field, including trainees and early-career professionals, may be particularly vulnerable to injuries compared to their more experienced counterparts. Implementing a systematic approach, such as that proposed by the National Institute for Occupational Safety and Health, could help reduce physical stress, discomfort, and the likelihood of musculoskeletal disorders for bronchoscopists. SUMMARY: Bronchoscopists increasingly face ergonomic issues in their practice. Despite available measures to address these problems, the field lacks uniform ergonomic guidelines for bronchoscopy. To safeguard bronchoscopists' health and safety from the outset of their careers, more studies and training focused on ergonomics in bronchoscopy are needed.
Bedside to bench and back again-translational research in interventional pulmonology.
Iqbal B, Choi HJ, Kanellakis NI … +2 more , Akulian J, Rahman NM
Curr Opin Pulm Med · 2025 Jan · PMID 39412040 · Full text
PURPOSE OF REVIEW: Translational research in Interventional Pulmonology has made significant advances in recent years, ranging from novel biomarkers and imaging to practice-changing clinical trials in lung cancer and ple...
PURPOSE OF REVIEW: Translational research in Interventional Pulmonology has made significant advances in recent years, ranging from novel biomarkers and imaging to practice-changing clinical trials in lung cancer and pleural disease. This review article aims to summarize key research studies in the field to understand the latest published evidence and to highlight areas of growing academic interest. RECENT FINDINGS: In lung cancer, the role of novel imaging and biomarkers and their potential utility in early lung cancer diagnosis will be highlighted. In pleural disease, less invasive/conservative treatment in pneumothorax, early aggressive treatment in pleural infection along with novel biomarkers, and the shift beyond drainage strategies in malignant pleural effusion and mesothelioma will be discussed. SUMMARY: This overview of translational research in the field of interventional pulmonology will ultimately help to highlight the gaps in current evidence to promote research in areas of clinical significance.
Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens.
Jafta N, Shezi B, Buthelezi M … +2 more , Muteti-Fana S, Naidoo RN
Curr Opin Pulm Med · 2025 Mar · PMID 39410863 · Full text
PURPOSE OF REVIEW: Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- an...
PURPOSE OF REVIEW: Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa. RECENT FINDINGS: African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent. SUMMARY: Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.
Hypoxic burden - definitions, pathophysiological concepts, methods of evaluation, and clinical relevance.
Parekh A
Curr Opin Pulm Med · 2024 Nov · PMID 39229876 · Full text
PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is a common chronic condition that affects over a billion people worldwide and is associated with adverse cardio- and cerebrovascular consequences. Currently, the go-to cl...
PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is a common chronic condition that affects over a billion people worldwide and is associated with adverse cardio- and cerebrovascular consequences. Currently, the go-to clinical measure that determines the presence and severity of OSA is the apnea-hypopnea index (AHI). The AHI captures the frequency of respiratory events due to changes in ventilation that are associated with either oxygen desaturations or arousal from sleep. The AHI is poorly correlated to adverse outcomes in OSA with poor prognostic ability. To overcome the limitations of AHI and perhaps driven by the ease of acquisition, several studies have suggested characterizing nocturnal hypoxia in OSA, termed as "hypoxic burden". The purpose of this review is to focus on the hypoxic burden in OSA, its various definitions, and its utility in moving OSA diagnosis beyond the AHI. RECENT FINDINGS: Several measures and definitions of hypoxic burden have been proposed and studied that show promise in overcoming limitations of AHI and also have a greater prognostic ability than AHI. More recently, area-based measures that attempt to characterize the depth and duration of oxygen desaturations, i.e., nocturnal hypoxia in OSA, have been shown to better relate to incident cardiovascular disease than AHI. In this review, we delve into the evidence for these novel area-based metrics and also delve into the pathophysiological concepts underlying nocturnal hypoxia while cautioning the reader on interpretation of the recent findings relating hypoxic burden to adverse outcomes in OSA. SUMMARY: In this review on hypoxic burden, we focus on the need that has driven the sudden influx of studies assessing hypoxic burden for various outcomes of OSA, its underlying pathophysiology, the various definitions, and clinical relevance. We hope that the reader can appreciate the nuances underlying hypoxic burden in OSA and suggest the need for a cohesive framework for moving beyond the AHI with hypoxic burden.
Pregnancy and fertility in people with cystic fibrosis following lung transplantation.
Taylor-Cousar JL, Sole A, Jain R
Curr Opin Pulm Med · 2024 Nov · PMID 39193883 · Full text
PURPOSE OF REVIEW: The purpose of this review is to summarize available data on fertility, fertility preservation, pregnancy and parenthood following lung transplantation for people with cystic fibrosis (pwCF). RECENT FI...
PURPOSE OF REVIEW: The purpose of this review is to summarize available data on fertility, fertility preservation, pregnancy and parenthood following lung transplantation for people with cystic fibrosis (pwCF). RECENT FINDINGS: In the era of cystic fibrosis transmembrane conductance regulator (CFTR) modulator use, oral therapies that positively impact fundamental CFTR protein abnormalities, the number of pregnancies has increased dramatically with a concomitant decrease in lung transplantation. Nonetheless, some pwCF still require lung transplantation as a life-saving measure, and a fraction of those individuals desires parenthood. Cystic fibrosis (CF) providers infrequently discuss fertility preservation with pwCF, and pwCF feel uneducated about their fertility options posttransplant. However, because the immunosuppression required to successfully maintain lung allografts may impact future fertility, pwCF should receive genetic and reproductive counseling prior to lung transplantation. While pregnancies posttransplantation are high-risk, selected females with CF may be able to pursue this path to parenthood. SUMMARY: Although there is a paucity of data specific to pwCF who have undergone lung transplantation, recently developed general guidelines should inform discussions regarding fertility, pregnancy and parenthood in pwCF who desire parenthood following lung transplantation for optimal shared decision-making.
'Personalized medicine': phenotyping pediatric obstructive sleep apnea.
Duong-Quy S, Nguyen-Ngoc-Quynh L, Nguyen-Huu H
Curr Opin Pulm Med · 2024 Nov · PMID 39193881 · Publisher ↗
PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is common in children. Phenotyping pediatric OSA has a crucial role in personalized diagnosis and treatment to improve outcomes for this population. This review sets forth...
PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is common in children. Phenotyping pediatric OSA has a crucial role in personalized diagnosis and treatment to improve outcomes for this population. This review sets forth a clinical approach that allows for phenotyping pediatric OSA. RECENT FINDINGS: The emerging concept of phenotyping pediatric OSA is based on identifying a primary cause, which leads to a more precise understanding of the pathogenesis in any individual patient. Phenotyping enables treatment focusing on the primary cause, but does not exclude the need for supplemental management strategies based on other recognizable traits. The identification of pediatric OSA phenotypes (POP) relies on observable characteristics with significant prevalence. This review will concentrate on the most important phenotypes seen in clinical practice: pediatric OSA with craniofacial abnormalities (POPCA); OSA with upper airway disease (POPUAD); OSA with obesity (POPO), and OSA associated with neuromuscular disease (POPNED). SUMMARY: Phenotyping pediatric OSA is a form of personalized medicine. By identifying clinical subtypes, individualized treatment plans can be devised in order to choose therapies that are associated with predictable responses. Moreover, it is rare that a therapeutic modality is devoid of possible complications; knowledge of the phenotype being treated can enable early intervention should those occur. Finally, all of the aforementioned phenotypes require personalized support incorporating individualized care plans so as to optimize the quality of life and overall sleep health of children with OSA.
Predictors and markers of the cardiovascular impact of obstructive sleep apnoea.
Dodani K, Pinilla L, Sánchez-de-la-Torre M
Curr Opin Pulm Med · 2024 Nov · PMID 39189145 · Publisher ↗
PURPOSE OF REVIEW: Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing and has been linked to cardiovascular health. However, some of the findings supporting this are controversial. These...
PURPOSE OF REVIEW: Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing and has been linked to cardiovascular health. However, some of the findings supporting this are controversial. These discrepancies might be a result of heterogeneity among OSA patients, and thus, additional information would be required to better stratify OSA patients according to cardiovascular risk. In this review, we aim to discuss the potential of biomarkers to fulfil this role. RECENT FINDINGS: Randomized controlled trials have been unable to confirm whether OSA treatment with continuous positive airway pressure (CPAP) has a positive effect on cardiovascular outcomes. Emerging physiology-based metrics of OSA seem to be more suitable for identifying patients at higher risk of cardiovascular disease and predicting the effects of CPAP outcomes on cardiovascular health. Similarly, blood-based molecular markers have gained attention in this context over the last few years. SUMMARY: Accurate cardiovascular risk stratification and appropriate treatment allocation for OSA patients remain challenging. However, significant efforts are being made to develop novel tools to address these important issues.
Sex differences in sleep and sleep-disordered breathing.
Schwarz EI, Schiza S
Curr Opin Pulm Med · 2024 Nov · PMID 39189037 · Full text
PURPOSE OF REVIEW: There is increasing evidence for relevant sex differences in pathophysiology, symptom presentation and outcomes in obstructive sleep apnoea (OSA). However, research on sex differences and sex-specific...
PURPOSE OF REVIEW: There is increasing evidence for relevant sex differences in pathophysiology, symptom presentation and outcomes in obstructive sleep apnoea (OSA). However, research on sex differences and sex-specific phenotypes in sleep-disordered breathing (SDB) is still in its infancy and data on sex differences in other SDB is still very scarce. RECENT FINDINGS: While OSA is more common in men than in premenopausal women, the prevalence of OSA doubles postmenopausally and becomes comparable to that of men. Women have a lower collapsibility of the upper airway and a lower arousal threshold. In addition, the rapid eye movement (REM)-apnoea-hypopnoea index (AHI) is typically higher in women than in men, but the non-REM-AHI and thus the total AHI is often lower. Women are often symptomatic at lower AHI and present more frequently with symptoms of sleep fragmentation and poor sleep quality. Both certain forms of OSA (e.g. REM-OSA) and certain phenotypes (e.g. COMISA) are more common in women. Men have a higher risk of high loop gain central sleep apnoea. SUMMARY: For a better understanding of sex-typical phenotypes with the aim of a more targeted treatment approach of SDB, adequately powered studies on sex differences in SDB should be conducted.
Epidemiology of advanced cystic fibrosis lung disease in the modulator era.
Westhoff J, Naehrlich L
Curr Opin Pulm Med · 2024 Nov · PMID 39171565 · Publisher ↗
PURPOSE OF REVIEW: Advanced cystic fibrosis lung disease remains the main cause of death in people with cystic fibrosis (pwCF). Cystic fibrosis transmembrane regulator (CFTR) modulators have changed the disease burden fo...
PURPOSE OF REVIEW: Advanced cystic fibrosis lung disease remains the main cause of death in people with cystic fibrosis (pwCF). Cystic fibrosis transmembrane regulator (CFTR) modulators have changed the disease burden for eligible pwCF with access to this therapy. RECENT FINDINGS: Real-world data show that there are no safety concerns for patients with advanced cystic fibrosis lung disease treated with highly effective triple CFTR modulator therapy. The improvements are comparable to those in other people with cystic fibrosis and in part even better. Mortality and rates of lung transplantation have decreased since the approval of CFTR modulator therapy and, especially, highly effective triple CFTR modulator therapy. Nevertheless, at least 10% of people with cystic fibrosis are not eligible for highly effective CFTR modulator therapy, and the development of alternative treatments remains important. SUMMARY: The approval of highly effective CFTR modulator therapies has been a breakthrough in treatment for most people with cystic fibrosis, especially those with advanced lung disease, improving survival and reducing the burden of the disease.
Lung transplant referral considerations for individuals with cystic fibrosis.
McLafferty FS, Gray AL
Curr Opin Pulm Med · 2024 Nov · PMID 39132757 · Publisher ↗
PURPOSE OF REVIEW: The cystic fibrosis (CF) Foundation issued guidelines to promote timely lung transplant referral for people with cystic fibrosis (pwCF) in 2019. Since then more has been published to help refine this c...
PURPOSE OF REVIEW: The cystic fibrosis (CF) Foundation issued guidelines to promote timely lung transplant referral for people with cystic fibrosis (pwCF) in 2019. Since then more has been published to help refine this complex decision. The goal of this review is to summarize the recent literature informing disease severity in CF, barriers to referral for pwCF and guide timely and appropriate lung transplant referrals. RECENT FINDINGS: Existing guidelines utilize the degree of airflow limitation as the primary criteria to refer for lung transplant, yet this variable has some prognostic uncertainty. Novel prognostic tools may provide more reliable metrics for predicting who with CF is at greatest risk of dying from their lung disease and could be used as an indicator for when to refer. In addition, updated analyses of national registry data have highlighted the significance of hemoptysis, low body mass index, and extra-pulmonary organ failure, as important prognostic markers. PwCF with these complications have historically been under-referred for lung transplant despite data suggesting lung transplant can be safe for some in these populations. Early referral should be considered in the presence of these complications. SUMMARY: This review builds on existing guidelines by incorporating novel data to better determine when lung transplant referral is most appropriate. Improved prognostic tools are still needed to decrease the chances of pwCF dying without consideration of lung transplant. It is still unclear how novel therapies for CF may change the need and timing for lung transplant referral.
Exploring the role of dreams: insights from recent studies.
Scarpelli S, Alfonsi V, De Gennaro L
Curr Opin Pulm Med · 2024 Nov · PMID 39115405 · Publisher ↗
PURPOSE OF REVIEW: Dreaming has only recently become a topic of scientific research. This review updates current findings on dream studies, emphasizing recent research on the neural mechanisms of dreaming. Additionally,...
PURPOSE OF REVIEW: Dreaming has only recently become a topic of scientific research. This review updates current findings on dream studies, emphasizing recent research on the neural mechanisms of dreaming. Additionally, it summarizes new evidence on the functional role of dreams, including insights from studies on dreams and nightmares during the coronavirus disease 2019 (COVID-19) pandemic. RECENT FINDINGS: Recent advances on the neural basis of mental activity during sleep have shifted towards dream-related phenomena, such as dream experiences in relation to parasomnias and hypnagogic hallucinations. Although some findings are consistent with the main models explaining dream recall (i.e., continuity hypothesis; activation hypothesis), some results contrast with the role of parieto-occipital region in dream experience. Moreover, recent findings - related to COVID-19 pandemic - underlined that dream experiences could express emotion regulation processes as well as provide a simulation of reality to prepare for future dangerous or social interactions. SUMMARY: Overall, we highlighted the intricate interplay between brain regions in dreaming and suggest that dreams serve multiple functions, from reflecting waking-life experiences to simulating adaptive responses to threats. Understanding the neural bases and functions of dreaming can provide valuable insights into human mental health, nevertheless, further research is needed.
Accuracy of respiratory event indices downloaded from positive airway pressure devices: can they be relied upon when making treatment decisions?
Richter M, Schroeder M, Nilius G
Curr Opin Pulm Med · 2024 Nov · PMID 39115392 · Publisher ↗
PURPOSE OF REVIEW: The gold standard for diagnosis and treatment of obstructive sleep apnea (OSA) is attended overnight polysomnography (PSG) in a sleep laboratory. Alternative diagnostic techniques are urgently needed f...
PURPOSE OF REVIEW: The gold standard for diagnosis and treatment of obstructive sleep apnea (OSA) is attended overnight polysomnography (PSG) in a sleep laboratory. Alternative diagnostic techniques are urgently needed for both diagnosis and treatment control when initiating positive airway pressure (PAP) in the home setting. Current PAP devices compute data such as residual AHI (apnea-hypopnea index) using their proprietary algorithms to provide an automatic event detection (AED). It was suggested that these should be labeled AHI FLOW . RECENT FINDINGS: The current study situation shows an acceptable agreement with the tendency of mildly overestimating the AHI by the PAP devices. But, the literature is still limited in terms of accuracy, especially when considering the lack of standardization and different detection algorithms. SUMMARY: A validation of PAP devices regarding the agreement of AHI FLOW compared to AHI PSG is extremely important, given that the device analysis is exclusively based on the measured flow. There are considerable concerns about assessing the PAP effectiveness in higher risk groups based on the AED function alone. Given these reservations, the use of PAP event detection can be an important addition to the diagnostic spectrum and, in combination with telemonitoring, offers promising potential.
Evidence from recent clinical trials in fibrotic interstitial lung diseases.
Cottin V, Valenzuela C
Curr Opin Pulm Med · 2024 Sep · PMID 39114938 · Publisher ↗
PURPOSE OF REVIEW: Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrosing interstitial lung diseases. It is mirrored by progressive pulmonary fibrosis (PPF), an umbrella term which characterizes disease behavi...
PURPOSE OF REVIEW: Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrosing interstitial lung diseases. It is mirrored by progressive pulmonary fibrosis (PPF), an umbrella term which characterizes disease behavior of various fibrotic interstitial lung diseases with irreversible progression, accounting for loss of lung function, exercise intolerance and respiratory failure leading to early mortality. Pirfenidone and nintedanib halve the decline in lung function but do not halt disease progression. RECENT FINDINGS: Since the publication in 2014 of pivotal pirfenidone and nintedanib studies, a number of clinical trials were conducted, many of them did not reach their primary endpoints. In IPF, promising phase 2 trials were followed by large phase 3 trials that did not confirm a favorable efficacy to tolerability favorable profile, including those with ziritaxestat, an autotaxin-1 inhibitor, zinpentraxin-alpha (human recombinant pentraxin-2), and the monoclonal antibody pamrevlumab targeting connective tissue growth factor. Nevertheless, newer compounds that hold promise are currently being evaluated in phase 3 or phase 2b randomized controlled trials, including: nerandomilast, a preferential phosphodiesterase 4B inhibitor; admilparant, a lysophosphatidic acid receptor antagonist; inhaled treprostinil, a prostacyclin agonist; and bexotegrast, a dual-selective inhibitor of αvβ6 and αvβ1 integrins. Nerandomilast, admilparant, inhaled treprostinil, and inhaled AP01 (pirfenidone), are currently studied in patients with PPF. SUMMARY: Despite recent frustrating negative results, there is a growing portfolio of candidate drugs developed in both IPF and PPF.
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