Semin Respir Crit Care Med [JOURNAL]
Sun
200 papers
Emerging Trends in Global Lung Cancer Burden.
Shong LY, Lam DC
Semin Respir Crit Care Med · 2025 Oct · PMID 40812348 · Full text
Lung cancer remains the leading cause of cancer-related deaths worldwide, with its burden shaped by evolving risk factors, demographic changes, and healthcare disparities. Over the past decades, while age-standardized in...
Lung cancer remains the leading cause of cancer-related deaths worldwide, with its burden shaped by evolving risk factors, demographic changes, and healthcare disparities. Over the past decades, while age-standardized incidence and mortality rates have declined, the absolute number of cases has risen due to population growth and aging. Tobacco smoking remains the most common risk factor, accounting for approximately 60% of cases globally, though its contribution has declined in high-income regions due to effective tobacco control. Conversely, countries with lower socioeconomic development, particularly in East and South Asia, face rising incidence and mortality driven by increasing smoking prevalence, air pollution, and limited access to healthcare. Emerging risk factors, such as ambient air pollution and genetic predisposition, are increasingly significant, particularly in regions with lower Human Development Index scores. Sex disparities are evident, with lung cancer rates declining among men in many high-income countries but rising among women globally. Early-onset lung cancer is also an emerging concern, especially in middle socio-demographic index regions, driven by smoking, environmental exposures, and genetic factors. By 2035, it is predicted that lung cancer deaths could reach 3 million annually. To address the impact of the growing lung cancer burden, a multifaceted approach is needed, including strengthened tobacco control, improved air quality, promotion of clean cooking fuels, and expanded low-dose computed tomography screening, particularly in resource-constrained regions.
Management of Dyspnea in Patients with Neuromuscular Disorders.
Scullin D, Barney J
Semin Respir Crit Care Med · 2025 Jun · PMID 40812347 · Publisher ↗
Neuromuscular diseases encompass a wide array of clinical manifestations, age at presentation, and severity of morbidity and mortality. Central to most patients with these disorders are symptoms of dyspnea and increased...
Neuromuscular diseases encompass a wide array of clinical manifestations, age at presentation, and severity of morbidity and mortality. Central to most patients with these disorders are symptoms of dyspnea and increased work of breathing related to varying degrees of impairment of the neuromuscular apparatus. The degree of dyspnea is often compounded by impaired clearance from the tracheobronchial tree, leading to patients who are weak, dyspneic, and impacted by pulmonary secretions. Approaches to determining contributing causes and management of dyspnea in these patients vary among adult and pediatric patients and are also distinct depending on the natural progression of the specific neuromuscular disorder. We describe an approach to the management of dyspnea in patients with neuromuscular diseases and review the roles of pharmacologic and respiratory support devices in alleviating symptoms and supporting respiration.
Peeling Back the Layers of the Bleomycin Model of Lung Fibrosis: Lessons Learned, Factors to Consider, and Future Directions.
Brazee P, Allen N, Knipe R … +2 more , Redente EF, Le Saux CJ
Semin Respir Crit Care Med · 2025 Aug · PMID 40803339 · Publisher ↗
Bleomycin-induced lung injury remains the most widely used and well-characterized experimental model for studying pulmonary fibrosis, particularly idiopathic pulmonary fibrosis (IPF). This review provides a comprehensive...
Bleomycin-induced lung injury remains the most widely used and well-characterized experimental model for studying pulmonary fibrosis, particularly idiopathic pulmonary fibrosis (IPF). This review provides a comprehensive analysis of the bleomycin model's utility, phases, variability, and translational relevance. Bleomycin administration in rodents induces acute epithelial injury followed by inflammation, fibroblast activation, extracellular matrix deposition, and eventual fibrosis. The model progresses through defined stages, acute inflammation (days 1-7), fibrogenesis (days 7-28), and in most cases, spontaneous resolution (days 42-63), making it suitable for understanding temporal aspects of fibrosis and repair, the cell populations involved, and the signaling mechanisms involved. Despite its advantages, the single-dose model lacks key features of human IPF, including persistent fibrosis, honeycomb cysts, and fibroblastic foci. Repetitive dosing and the use of aged mice have improved chronicity and recapitulation of progressive disease and observation of the expansion of aberrant epithelial cell populations in simple cyst structures. This review discusses route-specific effects, strain and sex susceptibilities, and the growing role of microbiome and genetic background in influencing fibrosis outcomes. It also highlights cellular responses across epithelial cell populations, fibroblasts, endothelial cells, and immune cell populations. Although limitations exist in this model-such as reversibility and incomplete modeling of human pathology-bleomycin remains invaluable for mechanistic studies and preclinical drug screening. Importantly, all FDA-approved antifibrotic drugs demonstrated efficacy in bleomycin models prior to clinical success. The review advocates for careful model selection, incorporation of persistent fibrosis models, and parallel use of human-relevant systems to enhance translational relevance in pulmonary fibrosis research.
Lung Cancer in Special Populations.
Triplette M, Aldrich MC
Semin Respir Crit Care Med · 2025 Oct · PMID 40774326 · Publisher ↗
Lung cancer is the leading cause of cancer deaths worldwide, claiming more lives than other age-related and screen-detectable cancers. Cigarette smoking remains the most important risk factor. However, despite common per...
Lung cancer is the leading cause of cancer deaths worldwide, claiming more lives than other age-related and screen-detectable cancers. Cigarette smoking remains the most important risk factor. However, despite common perceptions, risk is not related solely to cigarette smoking. Several vulnerable and special populations experience a disproportionate burden of lung cancer, often complicated by overlapping medical issues, diagnostic challenges, and treatment limitations. This review highlights four populations (people with HIV, persons who are immunocompromised, lung cancer in nonsmoking women, and individuals with interstitial lung disease [ILD]) who experience unique risks that impact early detection, diagnosis, and management of lung cancer. Three of these populations are frequently underrepresented in clinical trials, yet they may be at elevated risk due to chronic inflammation, immune dysregulation, or previous medical therapies. Individuals with HIV have a significantly increased incidence of lung cancer, often presenting at younger ages and with more advanced disease. Similarly, patients who are immunocompromised following organ or stem cell transplantation are at heightened risk due to prolonged immune dysfunction and prior exposures to toxic therapies. Individuals with ILD, especially idiopathic pulmonary fibrosis (IPF), have an increased risk of developing lung cancer, which is challenging to detect with imaging given architectural distortion and even more challenging to treat given limited pulmonary reserve. We also highlight women, as there has been a striking trend of rising incidence of lung cancer among women worldwide, particularly among those who have never smoked. The intersection of these risks with traditional lung cancer risk factors like tobacco smoking highlights a critical need for increased awareness, improved risk stratification, and adapted screening strategies that take these complexities into account. In this review, we explore the epidemiology, clinical presentation, and early detection and management challenges unique to each population, underscoring the necessity of precision approaches to support individualized care.
Small-Cell Lung Cancer Updates.
Nie Y, Chiang AC
Semin Respir Crit Care Med · 2025 Oct · PMID 40774325 · Publisher ↗
Small-cell lung cancer (SCLC) is a high-grade, aggressive neuroendocrine tumor with a particularly poor prognosis, characterized by early metastases and rapid development of therapy resistance. There have historically be...
Small-cell lung cancer (SCLC) is a high-grade, aggressive neuroendocrine tumor with a particularly poor prognosis, characterized by early metastases and rapid development of therapy resistance. There have historically been few treatment options for advanced or extensive stage SCLC, which comprises 70% of patients at the time of diagnosis, and 5-year survival rates for these patients have been under 5% for decades. Treatment of SCLC is now undergoing rapid changes due to advances in the field and many promising clinical trials, with several new therapy approvals within the last year. Advanced SCLC treatment is now a combination of chemotherapy and immunotherapy in the first line, with multiple second and later-line options. Early-stage SCLC is treated with chemoradiation followed by consolidative immunotherapy, a change in practice based on a recent clinical trial demonstrating an improvement of almost 2 years in median overall survival. In the era of immunotherapy and novel agents, prognosis has improved for advanced-stage disease, with 3-year survival rates of 16 and 17% in clinical trials for chemoimmunotherapy combinations. Despite these advances, most patients will progress within 6 months of starting first-line chemoimmunotherapy; thus, this disease continues to represent an area of unmet need. This update will highlight current standard of care practices and updates of recent promising trials that have improved outcomes, including survival, for SCLC patients.
When Sleep and Breathing Don't Play Well in the Sandbody….
Barbé F, Targa ADS, Gozal D
Semin Respir Crit Care Med · 2025 Apr · PMID 40749663 · Publisher ↗
Abstract loading — click title to view on PubMed.
Update on Drug-Induced Pneumonitis in Lung Cancer.
McAvoy KA, Possick JD
Semin Respir Crit Care Med · 2025 Oct · PMID 40720981 · Publisher ↗
Drug-induced pneumonitis is a significant and potentially life-threatening complication associated with multiple lung cancer therapies. As novel therapies are introduced and incorporated into updated treatment algorithms...
Drug-induced pneumonitis is a significant and potentially life-threatening complication associated with multiple lung cancer therapies. As novel therapies are introduced and incorporated into updated treatment algorithms, it is crucial to anticipate, recognize, and manage these events readily and comprehensively. As experience with these agents accumulates in real-world settings, so too does our appreciation for patient risk factors, the need for personalized monitoring strategies, the heterogeneity of both clinical and radiographic presentations, and the persistent importance of a systematic approach to diagnosis and management. Novel therapies are responsible for significant improvements in lung cancer survival, but enthusiasm for this progress must be tempered by mitigation and management of inherent risks to avoid undue morbidity and mortality for our patients. Challenging clinical scenarios such as steroid-refractory pneumonitis highlight the importance of thorough evaluation, confident attribution, and aggressive early management. Future elucidation of the pathophysiology of these reactions will hopefully refine future diagnostic and therapeutic options. A collaborative, multidisciplinary approach is essential to optimize patient safety and outcomes in lung cancer care. In this study, we describe approaches to pretreatment assessment, evaluation of suspected pneumonitis, and management of pneumonitis on a drug-specific basis. We emphasize emerging data and drug classes, while also highlighting remaining areas of uncertainty.
Emerging Concepts in Fibroblast Biology and Progressive Pulmonary Fibrosis.
Singh P, Edjah S, Shi W … +1 more , Madala SK
Semin Respir Crit Care Med · 2025 Aug · PMID 40719115 · Publisher ↗
Pulmonary fibrosis is characterized by scarring and thickening of the lung parenchyma due to excessive deposition of collagen and other extracellular matrix (ECM) proteins. This leads to disruption of gas exchange areas...
Pulmonary fibrosis is characterized by scarring and thickening of the lung parenchyma due to excessive deposition of collagen and other extracellular matrix (ECM) proteins. This leads to disruption of gas exchange areas and ultimately respiratory failure, a pathology shared across multiple interstitial lung diseases (ILDs). Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive ILD characterized by exertional dyspnea, dry cough, and restrictive lung defects. Clinical progression is marked by worsening lung function, declining exercise tolerance, and hypoxemia. High-resolution computed tomography in IPF typically shows reticular opacities and honeycombing, predominantly distributed in the subpleural regions and lower lobes of the lungs. The disease course is variable, with episodes of acute exacerbation associated with high mortality. Myofibroblasts and fibroblasts are central drivers of fibrogenesis through uncontrolled proliferation, migration, survival, senescence, myofibroblast differentiation, and ECM production. Myofibroblasts represent a heterogeneous population in both origin and function, arising from diverse precursor cells, including lung resident fibroblasts, endothelial cells, and mesothelial cells, and are shaped by tissue-specific niches. Persistent activation of (myo)fibroblasts is sustained by a complex network of profibrotic growth factors and their downstream transcriptional regulators. In this review, we comprehensively examine the cellular origins and molecular pathways underlying fibroblast activation, with an emphasis on mechanistic insights that may inform the development of targeted antifibrotic therapies to attenuate disease progression and improve patient outcomes.
Emerging Concepts in Therapeutic Interventions for Idiopathic Pulmonary Fibrosis.
Schott CA, Mohning MP, Cooley JC
Semin Respir Crit Care Med · 2025 Aug · PMID 40633816 · Full text
Idiopathic pulmonary fibrosis (IPF) is a rare but devastating diagnosis for patients with only two approved drug therapies. Extensive preclinical studies have identified and characterized novel pathways driving IPF patho...
Idiopathic pulmonary fibrosis (IPF) is a rare but devastating diagnosis for patients with only two approved drug therapies. Extensive preclinical studies have identified and characterized novel pathways driving IPF pathogenesis, and researchers have identified several new promising therapeutic targets to help treat IPF. However, translating these preclinical models into viable treatment modalities has proven challenging. This review will address the evolving nature of IPF research, examine the preclinical studies and their target pathways that have advanced to clinical trials, and address the translational gap that has limited the success of novel therapeutic trials for IPF.
Lung Cancer with Cystic Airspace: An Overview.
Detterbeck FC, Ely S, Marom EM … +4 more , Rubinowitz AN, Traube L, Tanoue LT, Rivera MP
Semin Respir Crit Care Med · 2025 Oct · PMID 40633815 · Publisher ↗
There is increased recognition that some lung cancers arise from or are associated with air-filled cystic spaces. Recognition of precursors is important because these are often overlooked and because some of these cancer...
There is increased recognition that some lung cancers arise from or are associated with air-filled cystic spaces. Recognition of precursors is important because these are often overlooked and because some of these cancers progress rapidly once a solid component develops. A systematic review suggests that such precursors typically appear as irregular air cysts; these should be distinguished from bullae and smooth round cysts with paper-thin walls that are often seen incidentally with increasing age. Such irregular cysts usually enlarge slowly before developing a ground glass or small solid component or becoming multiloculated. Such change warrants careful surveillance; continued progression of a solid component justifies intervention. Early intervention is associated with good outcomes; survival markedly diminishes if resection occurs when a more substantial solid component has developed.
Surgical Therapy for Stage I Lung Cancer-Lobar versus Sublobar Resection.
Rudasill S, Farjah F
Semin Respir Crit Care Med · 2025 Oct · PMID 40623691 · Publisher ↗
Lung cancer is a leading cause of cancer-related mortality, but advances in screening and early detection have improved opportunities for curative treatment. Therapeutic intent surgical resection remains a cornerstone fo...
Lung cancer is a leading cause of cancer-related mortality, but advances in screening and early detection have improved opportunities for curative treatment. Therapeutic intent surgical resection remains a cornerstone for managing clinical stage IA disease. However, the optimal extent of surgical resection in this population has been a subject of ongoing debate. This review, guided by an introductory case-based vignette, provides a primer on the technical aspects of resection, pretreatment patient-level factors underlying decision-making, and other determinants of outcomes that may influence decisions to pursue lobar versus sublobar resection. We then offer a critique of the evidence base, focusing on the results of four randomized controlled trials: the Lung Cancer Study Group, DRKS00004897, JCOG0802/WJOG4607L, and CALGB140503. Following an interpretation of the available evidence, the review highlights contemporary practice patterns and the challenges of preference-based decisions. Finally, evidence gaps are highlighted as opportunities for future study to improve patient outcomes and experiences.
Molecular Markers in the Era of Precision Care in Lung Cancer.
Paranjpe I, Salter AI, Chen K … +1 more , Das M
Semin Respir Crit Care Med · 2025 Oct · PMID 40623690 · Publisher ↗
Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related deaths worldwide. The past two decades have brought advances in molecular profiling and the advent of therapies that specifically target genetic and...
Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related deaths worldwide. The past two decades have brought advances in molecular profiling and the advent of therapies that specifically target genetic and/or molecular alterations in NSCLC. There are now many FDA-approved targeted therapies for patients with metastatic lung cancer who harbor oncogenic driver alterations, including those in epidermal growth factor receptor, ALK receptor tyrosine kinase, KRAS proto-oncogene, GTPase, and others. These advances epitomize personalized medicine and improve patient outcomes compared with conventional cytotoxic chemotherapy. This review highlights the current and evolving landscape of targeted therapies in NSCLC, emphasizing key targets, resistance mechanisms, and new approaches poised to improve patient outcomes in the era of precision oncology. The next decade will likely be marked by further improvements in the specificity, duration of action, and toxicity profiles of targeted therapies, allowing patients to live longer and better lives.
Survivorship Challenges and Supportive Care in Lung Cancer.
Ha DM, Jacob RA, Bade BC
Semin Respir Crit Care Med · 2025 Oct · PMID 40623689 · Full text
The number of lung cancer survivors-anyone living with and beyond a lung cancer diagnosis-is increasing along with advances in screening, early detection, and treatment. Following diagnosis and treatment, however, many l...
The number of lung cancer survivors-anyone living with and beyond a lung cancer diagnosis-is increasing along with advances in screening, early detection, and treatment. Following diagnosis and treatment, however, many lung cancer survivors experience high symptom burden and functional challenges that culminate in poor health-related quality of life (HRQL). We incorporated the cancer life course endorsed by the United States National Academy of Medicine (formerly Institute of Medicine) and reviewed interventions to improve HRQL, starting from the time of diagnosis, during or following curative intent treatment, noncurative intent treatment, and continued until changes in disease status and/or goals of care. We reviewed clinical guidelines from the American College of Chest Physicians on HRQL following curative intent therapy, symptom management, and supportive care in lung cancer, as well as the role of exercise-based rehabilitation, complementary therapies, and integrative medicine. Moreover, we identified interventions evaluated in 19 randomized controlled trials (RCTs) or pilot RCTs in the past 10 years, involving 2,506 participants, to address HRQL challenges reported by ≥80% of lung cancer survivors as "important" or "very important": dyspnea, fatigue, sleep difficulties, fear/distress, anxiety, depressive symptoms, physical or role function/independence. This narrative review, which incorporates findings from physical exercise and rehabilitation, cognitive-behavioral and psychological therapies, mind-body therapies, mindfulness-based interventions, and other complementary therapies, has significant implications for enhancing the HRQL of the growing population of lung cancer survivors.
Perioperative and Peripartum Management of Patients with Neuromuscular Disease.
Williamson J, Edd T, Perez G … +1 more , Provost K
Semin Respir Crit Care Med · 2025 Jun · PMID 40570889 · Publisher ↗
Patients with neuromuscular disease are living longer with advancements in respiratory assistive devices for airway clearance and ventilatory support. This technology has been successfully applied to the perioperative an...
Patients with neuromuscular disease are living longer with advancements in respiratory assistive devices for airway clearance and ventilatory support. This technology has been successfully applied to the perioperative and peripartum periods, making these previously prohibitively high-risk procedures now a risk-controlled intervention. This review will cover preoperative planning and assessment, key intraoperative management interventions, postoperative management, and peripartum management for patients with neuromuscular disorders.
Respiratory Syncytial Virus Prevention in the Adult Population: State of the Art.
Bigoni T, Alfano F, Aloe F … +4 more , Baraldi F, Caggiano FP, Tarczal OD, Papi A
Semin Respir Crit Care Med · 2025 Feb · PMID 40480248 · Publisher ↗
Respiratory syncytial virus (RSV) is a common respiratory virus associated with acute respiratory infections (ARIs) in infants and older adults. RSV-related ARIs significantly affect the relevant clinical outcomes, inclu...
Respiratory syncytial virus (RSV) is a common respiratory virus associated with acute respiratory infections (ARIs) in infants and older adults. RSV-related ARIs significantly affect the relevant clinical outcomes, including hospitalization and mortality, in older adults. Elderly individuals and those with chronic diseases are at a higher risk of infections with severe morbidity because of clinical frailty and deficiencies in immune responses. Prevention of respiratory viral infections in the adult population can be achieved through hygiene measures and active immunization. Several vaccination strategies have been developed, including nucleic acid, subunit, chimeric, live-attenuated, particle-based, and recombinant vaccines, with varying results. Subunit vaccines involving the RSV-fusion protein F in its prefusional (pre-F) conformation, with or without adjuvants, have demonstrated significant protection in older adults, reducing the rate of total and severe RSV-related lower tract respiratory diseases (LRTDs). Similarly, an mRNA vaccine encoding for the stabilized pre-F conformation showed a significantly reduced RSV-associated LRTDs in older adults. This evidence led to recent approval of two subunit vaccines (Arexvy and Abrysvo) and one nucleic acid-based vaccine (mResvia) by regulatory authorities. Currently, several vaccines are recommended for adults, resulting in crowded schedules. Therefore, covaccination is a potential strategy for improving vaccine adherence. The coadministration of approved RSV vaccines with seasonal influenza vaccines has been proven to be non-inferior to the immune response from sequential administration. Other vaccines coadministered against different pathogens are currently under investigation.
Pertussis Vaccination: The Challenges Ahead.
Guiso N, Koenig CHWV
Semin Respir Crit Care Med · 2025 Feb · PMID 40480247 · Publisher ↗
Pertussis, a highly contagious respiratory disease, is preventable with vaccine. Two types of vaccines are used around the world: whole-cell pertussis vaccines (wP), which contain inactivated bacterial suspensions are di...
Pertussis, a highly contagious respiratory disease, is preventable with vaccine. Two types of vaccines are used around the world: whole-cell pertussis vaccines (wP), which contain inactivated bacterial suspensions are difficult to produce and induce some side effects, and acellular pertussis vaccines (aP), which contain one to five purified bacterial antigens, chemically or genetically detoxified. Both the vaccines succeeded in massively decreasing child deaths caused by pertussis. However, irrespective of vaccination, the disease is still endemic around the world, and cycles of pertussis are still observed every 3 to 5 years in both wP- or aP-vaccinated regions. The interval between each cycle, and the intensity and incidence of the disease during these cycles vary. The first challenge ahead is to rapidly increase vaccine coverage by vaccinating infants on time, introducing regular vaccine boosters throughout life, and vaccinating pregnant women. The second challenge is to introduce an effective disease surveillance such as a pediatric hospital surveillance, allowing an estimation of the incidence of severe disease in the pediatric population, and/or a sentinel surveillance, allowing to detect changes in the incidence of the disease in the population. All surveillance systems require a functional network of physicians in the country aware of the clinical forms of the disease in children, adolescents, adults, and seniors. Surveillance is required to adapt vaccine strategies according to the vaccine type and to follow the evolution of the agents of the disease. The third challenge is to pursue research to improve these vaccines. However, before changing vaccines once again, an evaluation of the exact consequences of aP or wP vaccines under specific vaccine strategies needs to be carefully carried out.
Clinical Course and Outcomes in Patients with Sjögren's Associated Interstitial Lung Disease.
Saluja P, Marco JL, Gautam N … +3 more , Chhakchhuak CL, Gardner GC, Gupta N
Semin Respir Crit Care Med · 2025 Jun · PMID 40446838 · Publisher ↗
Lung involvement in Sjögren's disease (SjD) is common and significantly impacts patients' quality of life, with the most frequent manifestation being interstitial lung disease (ILD). This study explored the clinical cour...
Lung involvement in Sjögren's disease (SjD) is common and significantly impacts patients' quality of life, with the most frequent manifestation being interstitial lung disease (ILD). This study explored the clinical course and prognostic factors in patients with SjD-associated ILD. We conducted a retrospective analysis of patients diagnosed with SjD-ILD across two tertiary care academic referral centers. We assessed key clinical, radiological, and histopathological features of patients with SjD-ILD to investigate the long-term outcomes and determine the factors that can help better prognosticate patients in the clinic. A total of 81 patients with SjD-ILD were included in our analysis. ILD was the presenting manifestation in 21% ( = 17) of the SjD patients. The median survival following diagnosis of SjD-ILD was 11 years. Among ILD subtypes, the UIP pattern was associated with more rapid lung function decline and higher mortality. In contrast, higher baseline forced vital capacity (FVC) and anti-SSA antibody positivity were linked to reduced mortality risk. ILD is a common manifestation that can lead to the diagnosis of SjD. The presence of ILD has an adverse effect on the overall survival of patients with SjD. Baseline lung function and serologies can further assist in prognostication. A critical review of imaging patterns to determine the underlying ILD pattern can aid individualized counseling and therapeutic decision-making in patients with SjD-ILD.
Precision Medicine to Guide Obstructive Sleep Apnea Treatment Beyond the Continuous Positive Airway Pressure.
Labarca G, Henríquez-Beltrán M, Solomons D
Semin Respir Crit Care Med · 2025 Apr · PMID 40409275 · Publisher ↗
Obstructive sleep apnea (OSA) is a widespread condition associated with an elevated risk of adverse outcomes. Continuous positive airway pressure (CPAP) is the gold standard treatment, particularly for moderate to severe...
Obstructive sleep apnea (OSA) is a widespread condition associated with an elevated risk of adverse outcomes. Continuous positive airway pressure (CPAP) is the gold standard treatment, particularly for moderate to severe OSA. However, in many instances, CPAP compliance falls short of expectations, necessitating physicians to consider additional interventions to alleviate patient symptoms. A comprehensive understanding of OSA endotypes and phenotypes can potentially enhance the confidence in selecting the appropriate combination or intervention to improve patient care. In this review, we will discuss various interventions and medications available to enhance the treatment of patients with OSA, following a precision medicine approach.
Nocturnal Hypoxemia in Respiratory Medicine: Pathophysiology, Measurement, and Association with Outcomes.
Hajipour M, Labarca G, Ayas N … +1 more , Azarbarzin A
Semin Respir Crit Care Med · 2025 Apr · PMID 40404132 · Publisher ↗
Nocturnal hypoxemia is a prevalent feature of various respiratory diseases, significantly impacting patient outcomes and therapeutic strategies. Oximetry, a noninvasive and widely accessible tool, enables the measurement...
Nocturnal hypoxemia is a prevalent feature of various respiratory diseases, significantly impacting patient outcomes and therapeutic strategies. Oximetry, a noninvasive and widely accessible tool, enables the measurement of nocturnal hypoxemia through oxyhemoglobin saturation (SpO)-derived metrics such as the oxygen desaturation index, percentage of sleep time with SpO below 90%, mean SpO, and measures of the area under the desaturation curve (e.g., sleep apnea-specific hypoxic burden). While these metrics are well established in obstructive sleep apnea (OSA), their application in other respiratory conditions, including chronic obstructive pulmonary disease, pulmonary hypertension, obesity hypoventilation syndrome, heart failure, neuromuscular disorders, pregnancy, and high-altitude residents, remains an area of active investigation. This review explores the pathophysiology of hypoxemia in these conditions and evaluates the role of SpO-derived metrics in risk stratification beyond OSA. We also discuss the challenges of interpreting SpO data, particularly the difficulty differentiating disease-related hypoxemia from comorbid OSA. Additionally, we examine the limitations of oximetry, including sensor inaccuracies, motion artifacts, and skin pigmentation. Finally, we emphasize the need for further research to standardize these metrics across diverse conditions and advocate for their integration into clinical practice to enhance patient management and outcomes.
Life After COVID-19: Alterations Related to Sleep and Circadian Rhythms.
Targa ADS, Henríquez-Beltrán M, Galan-Gonzalez A … +1 more , Barbé F
Semin Respir Crit Care Med · 2025 Apr · PMID 40398650 · Publisher ↗
World Health Organization (WHO) estimates reveal that over 777 million people were reportedly infected by SARS-CoV-2, with approximately 7 million deaths and 770 million surviving the disease up to April 2025. Beyond the...
World Health Organization (WHO) estimates reveal that over 777 million people were reportedly infected by SARS-CoV-2, with approximately 7 million deaths and 770 million surviving the disease up to April 2025. Beyond the immediate social and economic impact, an additional challenge arises as a large percentage of COVID-19 survivors report a wide range of symptoms after the acute phase, including fatigue, shortness of breath, cognitive difficulties, joint and muscle pain, chest pain, heart palpitations, loss of taste or smell, headaches, depression, anxiety, and sleep and circadian alterations. In this chapter, we will specifically address the sleep- and circadian rhythm-related alterations within this context. First, we will focus on sleep-related changes following the acute phase of the disease, detailing their manifestations, prevalence, and associated factors. We will then discuss the potential impact of these sleep-related aspects on the risk of SARS-CoV-2 infection, the severity of COVID-19, and the presence of post-COVID-19 conditions. A similar approach will be applied to address the circadian-related alterations. Finally, we will provide a comprehensive discussion on the overall limitations of available knowledge and its applicability, highlighting the relevance of these findings for the present and future.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe