Seminars In Respiratory And Critical Care Medicine[JOURNAL]
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200 papers
Sleep and Cardiovascular Health.
Pinilla L, Cano-Pumarega I, Sánchez-de-la-Torre M
Semin Respir Crit Care Med · 2025 Apr · PMID 40398649 · Publisher ↗
Sleep is recognized as a foundational pillar of health, essential for maintaining nearly all vital processes, and a crucial component of cardiovascular function. In recent years, there has been a paradigm shift to concep...
Sleep is recognized as a foundational pillar of health, essential for maintaining nearly all vital processes, and a crucial component of cardiovascular function. In recent years, there has been a paradigm shift to conceptualize sleep health as a combination of multiple domains, including duration, timing, quality, variability/regularity, habits/behaviors, and disordered sleep. This review provides a comprehensive overview of the current evidence linking the multifaceted elements that contribute to healthy sleep with cardiovascular and blood pressure-related outcomes. The reviewed literature indicates a strong relationship between sleep and cardiovascular health. However, the specific pathophysiological mechanisms that bridge the various dimensions of sleep with cardiovascular outcomes remain elusive. Given the global burden of cardiovascular disease, understanding the interplay between sleep and cardiovascular health has important implications for both individual and population health. Sustained efforts to move beyond a focus on discrete domains of sleep are essential to fully understand this complex and potentially bidirectional relationship. Promoting healthy sleep patterns and optimizing the management and treatment of sleep disorders are key steps toward developing more comprehensive strategies for reducing cardiovascular risk. Integrating sleep health into routine clinical care is identified as a critical opportunity to enhance cardiovascular disease prevention and management, particularly among vulnerable and high-risk populations.
Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease Overlap Syndrome.
Marin-Oto M, Sanz-Rubio D, Marin JM
Semin Respir Crit Care Med · 2025 Apr · PMID 40262777 · Publisher ↗
The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in the same patients is defined as COPD/OSA overlap syndrome (OVL). OSA and sleep complaints are quite common among COPD p...
The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in the same patients is defined as COPD/OSA overlap syndrome (OVL). OSA and sleep complaints are quite common among COPD patients and contribute to an increase in the risk of COPD exacerbation and mortality. Patients with OVL are more likely to develop cardiometabolic disease than patients with OSA or COPD alone. We must consider OSA as a treatable trait since the use of positive pressure ventilation reduces severe exacerbations, all-cause hospitalizations, and mortality in patients with COPD.
Comorbid Insomnia and Sleep Apnea: From Research to Clinical Practice.
Meira E Cruz M, Sweetman A
Semin Respir Crit Care Med · 2025 Apr · PMID 40258387 · Publisher ↗
Comorbid insomnia and sleep apnea (COMISA) represents a highly prevalent and clinically significant overlap between the two most common sleep disorders: insomnia and obstructive sleep apnea (OSA). COMISA is associated wi...
Comorbid insomnia and sleep apnea (COMISA) represents a highly prevalent and clinically significant overlap between the two most common sleep disorders: insomnia and obstructive sleep apnea (OSA). COMISA is associated with greater impairment in sleep, daytime functioning, and physical and mental health compared with insomnia or OSA alone. Despite its prevalence, COMISA has historically been underrecognized, partially due to the conflicting symptoms of insomnia (e.g., hyperarousal and sleeplessness) and OSA (e.g., sleep fragmentation and excessive daytime sleepiness). Recent research highlights that COMISA is not merely the coexistence of insomnia and OSA but may involve unique pathophysiological interactions and clinical phenotypes. This review explores the epidemiology, mechanisms, and clinical manifestations of COMISA. We examine insomnia as a potential extension of OSA, where repeated apneic events lead to conditioned hyperarousal, as well as OSA as an extension of chronic insomnia through mechanisms such as autonomic dysregulation and respiratory instability. Furthermore, we consider COMISA as a distinct entity, characterized by bidirectional interactions between the two conditions that exacerbate their clinical and physiological burden. Key challenges in diagnosing COMISA are discussed, including overlapping symptoms and limitations in current assessment tools. Emerging evidence suggests that COMISA is associated with increased cardiovascular and metabolic risks, greater mental health burden, and reduced treatment adherence to positive airway pressure (PAP) therapy. Advances in tailored therapeutic approaches, including combined cognitive-behavioral therapy for insomnia and OSA management strategies, are highlighted as promising avenues to improve outcomes. Understanding COMISA as a multidimensional condition with diverse phenotypes and mechanisms underscores the need for integrated diagnostic frameworks and personalized treatment strategies to optimize patient care. Further research into its unique features and long-term consequences is critical to advancing clinical practice in sleep and respiratory medicine.
Phenotypes of Obesity Hypoventilation Syndrome: Characteristics and Outcomes.
Masa-Jiménez JF, Ramírez-Molina VR, De Dios-Calama C
Semin Respir Crit Care Med · 2025 Apr · PMID 40258386 · Publisher ↗
Obesity hypoventilation syndrome (OHS) is defined by the combination of obesity (body mass index [BMI] ≥30 kg/m), sleep-disordered breathing, and daytime hypercapnia (arterial carbon dioxide tension [PaCO] ≥45 mm Hg at s...
Obesity hypoventilation syndrome (OHS) is defined by the combination of obesity (body mass index [BMI] ≥30 kg/m), sleep-disordered breathing, and daytime hypercapnia (arterial carbon dioxide tension [PaCO] ≥45 mm Hg at sea level) during wakefulness occurring in the absence of an alternative neuromuscular, mechanical, or metabolic explanation for hypoventilation. Patients with OHS can be classified by phenotypes depending on whether or not they have obstructive respiratory events: hypoventilation and no or not significant obstructive sleep apnea (OSA) and hypoventilation and significant OSA; we also add a third phenotype, which is the hospitalized patient with acute-on-chronic respiratory failure. We describe the mid- and long-term outcomes with and without positive airway pressure (PAP) by these three phenotypes.
Next-Generation Pneumococcal Vaccines for Children and Adults.
Menéndez R, Garces-Sanchez M
Semin Respir Crit Care Med · 2025 Feb · PMID 40239956 · Publisher ↗
remains one of the leading causes of mortality and morbidity in children and in the elderly worldwide. Pneumococcal conjugated vaccines (PCVs) have reduced invasive and noninvasive pneumococcal disease in children and ad...
remains one of the leading causes of mortality and morbidity in children and in the elderly worldwide. Pneumococcal conjugated vaccines (PCVs) have reduced invasive and noninvasive pneumococcal disease in children and adults. However, challenges persist due to serotype replacement, epidemiological diversity, and global inequalities in vaccine access. The future of PCVs is structured around three major areas of innovation: expanding antigenic coverage, developing serotype-independent formulations, and introducing advanced technological platforms such as the multiple antigen presenting system. The challenge is to better improve immunogenicity beyond serotypes and to extend the global impact of vaccines with more equitable and effective global rates of vaccination.
What Is Next for COVID-19 Vaccination?
Trilla A, Trilla G, Aldea M … +1 more , Vilella A
Semin Respir Crit Care Med · 2025 Feb · PMID 40164121 · Publisher ↗
Whenever a new COVID-19 vaccination season starts, we must face new challenges, including which vaccines to use, the update of the high-risk groups to be vaccinated, and especially the type and amount of information to b...
Whenever a new COVID-19 vaccination season starts, we must face new challenges, including which vaccines to use, the update of the high-risk groups to be vaccinated, and especially the type and amount of information to be communicated to people in order to promote vaccination. COVID-19 vaccination recommendations should fit these specific conditions. The use of effective vaccines against the predominant SARS-CoV-2 virus variants and the extent of the immune response (waning immunity) are key aspects to try to protect better the high-risk populations. Updated vaccines are currently swiftly available. However, the number of people vaccinated with any additional booster dose is declining. Improved health information and training for health care professionals, together with the use of better tools to make simpler vaccination recommendations, can encourage higher vaccination rates. Addressing these challenges is essential to improve vaccination coverage and ensure adequate protection in the face of evolving COVID-19 threats. The SARS-CoV-2 virus has become a constant presence in our society. The virus changes but is neither endemic nor seasonal so far. The Omicron variant prevailed for nearly 2 years and now several of its subvariants like JN.1, KP.2, or XEC are or can be the dominant ones. In the face of this moving situation, the main message must be the same: COVID-19 vaccines are safe and effective. The role of current COVID-19 vaccination efforts is to mitigate the severity of the disease and reduce the risk of complications and death, instead of preventing most SARS-CoV-2 infections. New vaccines against COVID-19 are now at different stages of clinical research.
Evaluation of Neuromuscular Disease in Adults Presenting with Dyspnea.
Scullin D, Barney J
Semin Respir Crit Care Med · 2025 Jun · PMID 40164120 · Publisher ↗
Neuromuscular disorders in adults can present with a wide array of clinical features and vary from acute life-threatening complications such as respiratory failure to slow progressive weakness and comorbidity. Common to...
Neuromuscular disorders in adults can present with a wide array of clinical features and vary from acute life-threatening complications such as respiratory failure to slow progressive weakness and comorbidity. Common to most of these disorders are symptoms of weakness and dyspnea. Many patients with occult neuromuscular disorders will be evaluated for underlying cardiac and pulmonary disease by primary care and subspecialty providers and can experience delays in diagnosis due to challenges in attaining early neurological testing and recognizing vague symptoms as potentially arising from the neuromuscular apparatus. Additionally, many adults who develop neuromuscular disorders have concomitant cardiac or pulmonary disease and the presence of dyspnea or limitations in mobility are often attributed to these without pursuing further workup. We outline a review of neuromuscular diseases in adults and an approach to evaluation.
The Interplay between Asthma, Obesity, and Obstructive Sleep Apnea.
Rodriguez LR, Sharma S
Semin Respir Crit Care Med · 2025 Apr · PMID 40164119 · Publisher ↗
The interrelationship between asthma, obesity, and obstructive sleep apnea (OSA) presents a critical area of investigation within sleep medicine, given the rising prevalence of these conditions globally. This article exp...
The interrelationship between asthma, obesity, and obstructive sleep apnea (OSA) presents a critical area of investigation within sleep medicine, given the rising prevalence of these conditions globally. This article explores the multifactorial interactions among these three disorders that contribute to significant morbidity. Asthma, a chronic inflammatory condition of the airways, is one of the most common chronic respiratory conditions globally. Asthma in people with obesity is associated with poor asthma control, increased asthma severity, and an increased frequency of exacerbations. Obesity, characterized by excessive fat accumulation, is a well-established risk factor for the development of OSA. This sleep-related breathing disorder disrupts airflow during sleep due to pharyngeal collapse. Conversely, OSA may worsen asthma symptoms through intermittent hypoxia and sleep fragmentation, further complicating asthma management. This review analyzes existing literature to illustrate the bidirectional relationships among these conditions. It discusses the role of systemic inflammation, hormone dysregulation, and lifestyle factors, such as diet and physical inactivity, in the development and persistence of asthma and OSA in obese patients. Furthermore, it highlights the importance of comprehensive management strategies that address these overlapping disorders. Clinical implications are examined, with consideration given to the potential for targeted therapies and lifestyle interventions that could mitigate symptoms and improve the quality of life for affected individuals. Understanding these complex interactions is essential for healthcare practitioners in optimizing the management of patients with asthma, obesity, and OSA. By recognizing the interconnectedness of these conditions, clinicians can adopt a more holistic approach to treatment, leading to improved outcomes and a better understanding of the patient's overall health trajectory. Future research directions are suggested to investigate potential therapeutic interventions and the influence of socioeconomic factors on these chronic conditions.
Sleep and Circadian-Related Outcomes after Critical Illness.
Pisani MA
Semin Respir Crit Care Med · 2025 Apr · PMID 40164118 · Publisher ↗
Sleep and circadian disruptions are frequently reported in studies of critically ill patients. Less is known about sleep and circadian disruptions after an intensive care unit (ICU) admission. It is recognized now that s...
Sleep and circadian disruptions are frequently reported in studies of critically ill patients. Less is known about sleep and circadian disruptions after an intensive care unit (ICU) admission. It is recognized now that survivors of critical illness may develop what is termed post-intensive care syndrome (PICS) which is a constellation of symptoms of which two of the most prominent features are fatigue and sleep complaints. Clinicians and researchers are now recognizing the importance of examining symptoms in survivors which impact their quality of life. Although current data are limited this review addresses what is now known about sleep and circadian disruptions post-ICU. Current ongoing research and future studies should continue to inform our understanding of how critical illness and the ICU environment both influence long-term outcomes in critically ill patients.
The Critical Role of Sleep in Enhancing Pulmonary Rehabilitation Outcomes.
Henríquez-Beltrán M, González J, Labarca G … +1 more , Targa ADS
Semin Respir Crit Care Med · 2025 Apr · PMID 40164117 · Publisher ↗
Pulmonary rehabilitation is a comprehensive, interdisciplinary intervention that aims to enhance the physical and psychological well-being of individuals with chronic respiratory diseases. This approach entails the imple...
Pulmonary rehabilitation is a comprehensive, interdisciplinary intervention that aims to enhance the physical and psychological well-being of individuals with chronic respiratory diseases. This approach entails the implementation of tailored therapies, including exercise training, education, and behavioral modification. Sleep plays a crucial role in numerous physiological processes, including the regulation of inflammation and tissue repair, both of which are fundamental to the efficacy of rehabilitation. A paucity of optimal sleep health has been associated with deleterious effects on pivotal factors that are indispensable for favorable outcomes in pulmonary rehabilitation, including mental and physical health and immune function. This, in turn, may increase susceptibility to impaired pulmonary function. The integration of pulmonary rehabilitation protocols with healthy sleep practices is expected to yield significant improvements in lung function and overall health, which will, in turn, promote long-term adherence to rehabilitative behaviors. This study aims to examine the relationship between sleep health and pulmonary rehabilitation outcomes.
Early Experience on Universal Prophylaxis in Infants against Respiratory Syncytial Virus: Facts and Expectations.
Soriano-Arandes A, Creus-Costa A, Perramon-Malavez A … +10 more , Andrés C, Vila J, Gatell A, Piñana M, Serrano P, González-Sánchez A, Capdevila R, Prats C, Soler-Palacin P, Antón A
Semin Respir Crit Care Med · 2025 Feb · PMID 39900111 · Publisher ↗
During the 2023/24 season, nirsevimab significantly reduced the risk of bronchiolitis and confirmed respiratory syncytial virus (RSV) infections in primary care, hospital, and pediatric intensive care unit admissions amo...
During the 2023/24 season, nirsevimab significantly reduced the risk of bronchiolitis and confirmed respiratory syncytial virus (RSV) infections in primary care, hospital, and pediatric intensive care unit admissions among infants aged 0 to 11 months, even in a season with a high community RSV burden, particularly for older infants. These findings are very useful for public health authorities to continue to implement immunization campaigns against RSV in the coming seasons. Moreover, universal immunization against RSV represents a transformative step toward reducing the burden of RSV in infants. With promising evidence from recently published studies, the expectations for a reduction of RSV-associated hospitalizations, alongside the improvement of public health outcomes and equitable access to these measures, are high. However, achieving these goals will require addressing challenges related to vaccine uptake, funding, and RSV surveillance to prompt detect resistances due to mutations of the virus. These interventions need to be integrated into public health strategies because they hold the potential to make a significant impact on infant's health worldwide.
Sleep, Circadian Rhythms, and Lung Cancer.
Cooper DH, Almendros I, Kendzerska T
Semin Respir Crit Care Med · 2025 Apr · PMID 39900110 · Publisher ↗
Lung cancer is the leading cause of cancer-related mortality worldwide, with the prevalence of the disease continually rising. Therefore, identifying disease-modifying risk factors is critical, with increasing recognitio...
Lung cancer is the leading cause of cancer-related mortality worldwide, with the prevalence of the disease continually rising. Therefore, identifying disease-modifying risk factors is critical, with increasing recognition of the impact of sleep quality/sleep disorders. This narrative review summarizes the evidence on the role of five domains of sleep on lung cancer incidence and progression: (i) sleep quality/duration, (ii) sleep disordered breathing, (iii) circadian rhythm disturbances, (iv) sleep-related movement disorders, and (v) personal, environmental, and social factors that modulate each of these associations. Epidemiological evidence supports reduced sleep duration, increased sleep duration, poor sleep quality, insomnia, obstructive sleep apnea, evening chronotype, peripheral limb movements in sleep, and less robustly for night shift work and restless leg syndrome to be associated with increased risk of lung cancer development, with potential impacts on cancer survival outcomes. Proposed mechanisms underlying the biological plausibility of these epidemiological associations are also explored, with common theories relating to immune dysregulation, metabolic alterations, reductions in melatonin, sympathetic overactivation, increased reactive oxygen species, production of protumorigenic exosomes, and inflammation. We also summarized potential treatments addressing impaired sleep quality/sleep disorders and their ability to attenuate the risk of lung cancer and improve cancer survival. Although evidence on reversibility is inconsistent, there are trends toward positive outcomes. Future research should focus on clinical trials to confirm cause and effect relationships, large epidemiologic studies for incidence/prognosis, clarification on the relative efficacy of treatment modalities, and more in vivo animal models to establish the molecular mechanisms underlying these relationships.
Sleep and Respiratory Infections.
Boira I, Chiner E
Semin Respir Crit Care Med · 2025 Apr · PMID 39900109 · Publisher ↗
Sleep disorders that involve circadian rhythm disruption and sleep-disordered breathing (SDB) such as obstructive sleep apnea (OSA) are closely linked to respiratory infections. SDB leads to a proinflammatory state due t...
Sleep disorders that involve circadian rhythm disruption and sleep-disordered breathing (SDB) such as obstructive sleep apnea (OSA) are closely linked to respiratory infections. SDB leads to a proinflammatory state due to intermittent hypoxia, sleep fragmentation, increased oxidative stress, and elevation of inflammatory mediators such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and C-reactive protein (CRP). Furthermore, inflammatory mediator levels correlate with SDB severity, especially in people with OSA. Nocturnal microaspiration, gastroesophageal reflux, and associated comorbidities (e.g., obesity) increase the risk of community-acquired pneumonia, viral infections such as SARS-CoV-2, respiratory complications, and death. OSA has been associated with post-COVID syndrome. It also increases the risk of postoperative complications in both adults and children. Circadian rhythm disorders such as insomnia predispose to immune disorders and increase the risk of infection. Chronic conditions such as bronchiectasis, with or without concomitant cystic fibrosis, can lead to structural sleep changes and increase the risk of OSA due to chronic cough, arousals, aspirations, hypoxia, upper airway edema, and overexpression of proinflammatory cytokines. The protective effect of treatment for sleep disorders against respiratory infection is currently unknown. However, in people presenting with respiratory infection, it is important to test for SDB to prevent complications.
State of the Art and Emerging Technologies in Vaccine Design for Respiratory Pathogens.
Ridelfi M, Pierleoni G, Zucconi Galli Fonseca V … +3 more , Batani G, Rappuoli R, Sala C
Semin Respir Crit Care Med · 2025 Feb · PMID 39870103 · Publisher ↗
In this review, we present the efforts made so far in developing effective solutions to prevent infections caused by seven major respiratory pathogens: influenza virus, respiratory syncytial virus (RSV), the severe acute...
In this review, we present the efforts made so far in developing effective solutions to prevent infections caused by seven major respiratory pathogens: influenza virus, respiratory syncytial virus (RSV), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), , (), , and . Advancements driven by the recent coronavirus disease 2019 (COVID-19) crisis have largely focused on viruses, but effective prophylactic solutions for bacterial pathogens are also needed, especially in light of the antimicrobial resistance (AMR) phenomenon. Here, we discuss various innovative key technologies that can help address this critical need, such as (a) the development of Lung-on-Chip ex vivo models to gain a better understanding of the pathogenesis process and the host-microbe interactions; (b) a more thorough investigation of the mechanisms behind mucosal immunity as the first line of defense against pathogens; (c) the identification of correlates of protection (CoPs) which, in conjunction with the Reverse Vaccinology 2.0 approach, can push a more rational and targeted design of vaccines. By focusing on these critical areas, we expect substantial progress in the development of new vaccines against respiratory bacterial pathogens, thereby enhancing global health protection in the framework of the increasingly concerning AMR emergence.
Pulmonary Embolism and Obstructive Sleep Apnea.
García-Ortega A, Pedro-Tudela A, Taberner-Lino L … +3 more , Barreiro E, Martínez-García MÁ, Oscullo G
Semin Respir Crit Care Med · 2025 Apr · PMID 39842463 · Publisher ↗
Pulmonary embolism (PE) and obstructive sleep apnea (OSA) remain a major health issue worldwide with potential overlapping pathophysiological mechanisms. PE, the most severe form of venous thromboembolism, is associated...
Pulmonary embolism (PE) and obstructive sleep apnea (OSA) remain a major health issue worldwide with potential overlapping pathophysiological mechanisms. PE, the most severe form of venous thromboembolism, is associated with high morbidity and mortality, presenting challenges in management and prevention, especially in high-risk populations. OSA is a prevalent condition characterized by repeated episodes of upper airway closure resulting in intermittent hypoxia and sleep fragmentation. Although the understanding of epidemiological and pathogenic relationships between OSA and PE is still limited, current data suggest that interactions between these two conditions appear to be relevant. OSA is emerging as a novel risk factor for PE, potentially affecting all components of Virchow's triad: hypercoagulability, endothelial dysfunction, and venous stasis. Epidemiological studies indicate a high prevalence of undiagnosed OSA in acute PE patients. Moderate-to-severe OSA has been linked to worse clinical presentations and outcomes. Furthermore, OSA has been associated with increased risks of PE recurrence and mortality. Future research directions should include clarifying the bidirectional relationship between these conditions and evaluating the effectiveness and safety of continuous positive airway pressure therapy in improving outcomes in patients with concurrent acute PE and OSA.
Safety, Efficacy, and Effectiveness of Maternal Vaccination against Respiratory Infections in Young Infants.
Makan-Murphy N, Madhi SA, Dangor Z
Semin Respir Crit Care Med · 2025 Feb · PMID 39708836 · Publisher ↗
Lower respiratory tract infection (LRTI) is a major cause of neonatal morbidity and mortality worldwide. Maternal vaccination is an effective strategy in protecting young infants from LRTI, particularly in the first few...
Lower respiratory tract infection (LRTI) is a major cause of neonatal morbidity and mortality worldwide. Maternal vaccination is an effective strategy in protecting young infants from LRTI, particularly in the first few months after birth when infant is most vulnerable, and most primary childhood vaccinations have not been administered. Additionally, maternal vaccination protects the mother from illness during pregnancy and the postnatal period, and the developing fetus from adverse outcomes such as stillbirth and prematurity. In this paper, we review the safety, efficacy, and effectiveness of maternal vaccines against LRTIs, such as pertussis, influenza, coronavirus disease 2019, and respiratory syncytial virus.
Advances in Disease-Modifying Therapeutics for Chronic Neuromuscular Disorders.
Davalos L, Kushlaf H
Semin Respir Crit Care Med · 2025 Jun · PMID 39708835 · Publisher ↗
Neuromuscular disorders can cause respiratory impairment by affecting the muscle fibers, neuromuscular junction, or innervation of respiratory muscles, leading to significant morbidity and mortality. Over the past few ye...
Neuromuscular disorders can cause respiratory impairment by affecting the muscle fibers, neuromuscular junction, or innervation of respiratory muscles, leading to significant morbidity and mortality. Over the past few years, new disease-modifying therapies have been developed and made available for treating different neuromuscular disorders. Some of these therapies have remarkable effectiveness, resulting in the prevention and reduction of respiratory complications. For myasthenia gravis (MG), efgartigimod, ravulizumab, rozanolixizumab, and zilucoplan have been Food and Drug Administration (FDA)-approved for the treatment of acetylcholine receptor (AChR) antibody-positive generalized MG in the past 2 years. Rozanolixiumab is also approved for treating MG caused by muscle-specific tyrosine kinase (MuSK) antibodies. The new MG therapeutics target the complement system or block the neonatal fragment crystallizable (Fc) receptors (FcRn), leading to significant clinical improvement. For spinal muscular atrophy (SMA), nusinersen (intrathecal route) and risdiplam (oral route) modify the splicing of the gene, increasing the production of normal survival motor neuron (SMN) protein. Onasemnogene abeparvovec is a gene replacement therapy that encodes a functional SMN protein. All SMA medications, particularly onasemnogene abeparvovec, have led to clinically meaningful improvement. For late-onset Pompe disease (LOPD), avalglucosidase alfa has shown a greater improvement in respiratory function, ambulation, and functional outcomes in comparison to alglucosidase alfa, and cipaglucosidase alfa combined with miglustat has shown improvement in respiratory and motor function in a cohort of enzyme replacement therapy-experienced LOPD patients. Amyotrophic lateral sclerosis (ALS) remains a challenge. The two most recent FDA-approved medications, namely sodium phenylbutyrate and tofersen, may slow down the disease by a few months in a selected population but do not stop the progression of the disease.
Vaccination against Respiratory Infections in the Immunosenescent Older Adult Population: Challenges and Opportunities.
Ecarnot F, Maggi S
Semin Respir Crit Care Med · 2025 Feb · PMID 39662893 · Publisher ↗
Respiratory infections are associated with a huge burden of disease every year and disproportionately affect older adults, namely those aged 65 years and older. Older adults are at increased risk of infections compared w...
Respiratory infections are associated with a huge burden of disease every year and disproportionately affect older adults, namely those aged 65 years and older. Older adults are at increased risk of infections compared with their younger counterparts, and once infected, have a higher risk of experiencing severe disease course, complications, and long-term sequelae. Therefore, vaccination is clearly a key strategy to prevent infection and its attendant negative consequences. We review here the burden of common respiratory diseases in older adults, namely influenza, pneumococcal disease, and respiratory syncytial virus. We then review some of the challenges facing immunization of older adults, namely immunosenescence, inflammaging, and low vaccine uptake. Next, potential opportunities for overcoming these challenges are reviewed, including the use of higher antigen doses and/or adjuvants in vaccine formulations for older adults, and the potential of multiomics analyses to improve development, performance, and implementation of vaccines.
Ethical Issues and the Role of Palliative Care for Patients with Aspiration Pneumonia.
Rosen A, Hayward B
Semin Respir Crit Care Med · 2024 Dec · PMID 39612937 · Publisher ↗
Aspiration pneumonia is a clinical entity with important ethical considerations. It is imperative for clinicians to understand these considerations to best provide counsel to patients and their families, allowing them to...
Aspiration pneumonia is a clinical entity with important ethical considerations. It is imperative for clinicians to understand these considerations to best provide counsel to patients and their families, allowing them to make fully informed decisions. Given that aspiration pneumonia is frequently associated with end of life, there are palliative medicine principles that may help in the treatment of this disease.
Prevention of Aspiration: Oral Care, Antibiotics, Others.
Perticone ME, Manti A, Luna CM
Semin Respir Crit Care Med · 2024 Dec · PMID 39612936 · Publisher ↗
Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different m...
Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different mechanisms. Prevention of this condition is directed at the mechanism by which it occurs. The elderly are the most likely to suffer from aspiration pneumonia, occasionally due to issues related to poor dental health, but more frequently due to abnormal swallowing, which may appear after a stroke, a functional impairment related to aging, or may be part of a specific disease such as Parkinson's disease or some other nervous system condition. People with dysphagia complicated by pneumonia have limited feeding and become debilitated, and aspiration pneumonia in these individuals has a high mortality rate at 90 days. Dietary modifications, assistance with feeding, use of postures that facilitate a normal deglutition, rehabilitation, and use of medications to improve swallowing defects are the tools of medicine to overcome the obstacles to swallowing normally and prevent the development of aspiration pneumonia and its consequences.
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