{"title":"Remote exercise assessment in pulmonary hypertension.","authors":"Paula Appenzeller, Daniel Jeffery, Mark Toshner","doi":"10.1097/MCP.0000000000001277","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001277","url":null,"abstract":"<p><strong>Purpose of review: </strong>In pulmonary arterial hypertension (PAH), assessment of exercise provides important prognostic information. Recently, digital alternatives to traditional outcome measures, including digital versions of the six-minute walk test (6MWT), have been proposed. This review discusses existing methods of remote exercise assessment in PAH.</p><p><strong>Recent findings: </strong>Summary metrics from actigraphy (e.g. daily steps) show promise on a population level but show high variability (e.g. related to seasonality) that may obscure clinically important changes. Conversely, digital structured exercise tests (6MWT) have proven safe, accurate compared to gold-standard tests and well-accepted by patients. Implementation and underlying algorithms vary, depending on whether tests are performed indoors or outdoors, along fixed or free courses, using accelerometery or GPS, and are delivered through app-only or app-and-wearable platforms. Integration of physiological data from wearables enhance digital 6MWT performance and hold promise as longitudinal endpoints. Key challenges include continued patient adherence and rigorous pre-processing of the raw data to ensure sustained data quality.</p><p><strong>Summary: </strong>Future studies are needed to demonstrate the ability of the digital 6MWT or alternative exercise measures to reflect disease severity, show sensitivity to change and establish minimal clinically important differences for them to be implemented in clinical care for longitudinal monitoring.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shelsey W Johnson, Farbod N Rahaghi, Raul San Jose Estépar
{"title":"The clinical relevance of chest computed tomography imaging in pulmonary hypertension associated with lung diseases.","authors":"Shelsey W Johnson, Farbod N Rahaghi, Raul San Jose Estépar","doi":"10.1097/MCP.0000000000001282","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001282","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to describe the use of chest computed tomography (CT) data to expand sub-phenotyping of pulmonary hypertension associated with chronic lung disease (Group 3 pulmonary hypertension) and inform identification of effective treatment.</p><p><strong>Recent findings: </strong>In the last 5 years, breakthroughs in clinical pulmonary hypertension research highlight the importance of chest CT data to inform disease trajectory and mortality risk. In presumed idiopathic pulmonary arterial hypertension (Group 1 pulmonary hypertension), a Group 1 'lung phenotype' with abnormal CT chest findings such as emphysema and fibrosis, experiences a mortality risk similar to that of Group 3 disease. Post hoc analyses of Group 3 pulmonary hypertension clinical trials highlight CT abnormalities to inform adverse treatment response, with implications for additional failed clinical trials to date. In fact, pulmonary hypertension guidelines emphasize the critical role for acquisition of standardized high-resolution CT data at pulmonary hypertension diagnosis and clinical trial enrollment.</p><p><strong>Summary: </strong>Chest CT imaging is critical in the clinical management of pulmonary hypertension associated with chronic lung disease. Future research will not only incorporate CT data into Group 3 pulmonary hypertension phenotyping research but also consider treatment effect visualization on the lung parenchyma and pulmonary arterial vasculature as a novel clinical trial endpoint.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brandon Budhram, Sébastien Bonnet, Jason Weatherald
{"title":"Promising signalling pathways for the treatment of pulmonary arterial hypertension.","authors":"Brandon Budhram, Sébastien Bonnet, Jason Weatherald","doi":"10.1097/MCP.0000000000001278","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001278","url":null,"abstract":"<p><strong>Purpose of review: </strong>Improved understanding of the complex and interconnected mechanisms driving pulmonary arterial hypertension (PAH) has expanded therapeutic development beyond the traditional vasodilator pathways. This review summarizes recently established and emerging signalling pathways that may influence the next generation of targeted PAH therapies.</p><p><strong>Recent findings: </strong>The transforming growth factor-β (TGF-β) superfamily has emerged as a fourth major therapeutic pathway. Therapies that target this pathway, such as the activin signalling inhibitor sotatercept, have demonstrated significant clinical and hemodynamic benefits in large randomized clinical trials. Additional promising strategies focus on receptor tyrosine kinases - particularly platelet-derived growth factor receptor signalling - as well as hypoxia-related and metabolic reprogramming pathways. Growing evidence also supports the role of immune dysregulation, hormonal and neurohormonal signalling, and epigenetic, genetic, and cell-cycle abnormalities in the development of PAH.</p><p><strong>Summary: </strong>The therapeutic landscape in PAH is shifting toward mechanism-based therapies with the potential to modify disease progression. Continued translational research and upcoming clinical trials will be essential to define appropriate patient selection, optimize therapeutic strategies, and determine the short- and long-term benefit of these therapies on clinical and survival outcomes.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rethinking pneumonia in terms of the lung microbiome.","authors":"Nicolas Gordon, Leopoldo N Segal, Benjamin G Wu","doi":"10.1097/MCP.0000000000001247","DOIUrl":"10.1097/MCP.0000000000001247","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aggregates, analyzes, and summarizes the current understanding of the lung microbiome as it relates to pneumonia. We will review the composition and function of a healthy lung microbiome and conceptualize dysbiosis associated with pneumonia. Finally, we discuss how the lung microbiome impacts the diagnosis, prognostication and pathogenesis, and recovery from pneumonia.</p><p><strong>Recent findings: </strong>The most tangible benefit of studying the lung microbiome has been the identification of pathogenic organisms in suspected pneumonia; however, as there is a growing body of evidence that suggest the lung microbiome is critical to pneumonia. Generally, detection of potential pathogens such as Staphylococcus aureus , Pseudomonas aeruginosa , Streptococcus pneumoniae , and Escherichia coli can be found even when sampling the lung microbiome of healthy individuals, yet it is unclear what determines the transition from potential pathogens present as bystanders to pathogens driving the development of pneumonia. Analysis of the lung microbiome suggests that the loss of \"oral commensals\" (bacteria found in the oral microbiome) in the lower airways is associated with the development of pneumonia and may provide diagnostic and prognostic insights.</p><p><strong>Summary: </strong>The lung microbiome is a rich and dynamic ecosystem comprised of numerous bacterial, fungal, and viral taxa that may contribute to pneumonia pathogenesis. There is increasing evidence that the lung microbiome may provide insight into factors that determine the pathogenicity of respiratory microbes and the susceptibility of individuals to those pathogens.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"169-181"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander J K Wilkinson, Laura-Jane E Smith, Ashley Woodcock
{"title":"Green inhalers: reducing the carbon footprint of asthma care.","authors":"Alexander J K Wilkinson, Laura-Jane E Smith, Ashley Woodcock","doi":"10.1097/MCP.0000000000001252","DOIUrl":"10.1097/MCP.0000000000001252","url":null,"abstract":"<p><strong>Purpose of review: </strong>The respiratory community faces an urgent need to reduce the environmental impact of care as the wider climate crisis threatens to worsen airways disease worldwide. Inhalers contribute a disproportionate share of healthcare emissions because of the hydrofluorocarbon (HFC) propellants in pressurized metered-dose inhalers (pMDIs). We already have effective, low-carbon, per- and polyfluoroalkyl substances (non-PFAS) options; particularly dry-powder inhalers (DPIs). This review summarizes recent developments in propellant technology and evidence on optimizing asthma care to improve outcomes while lowering emissions.</p><p><strong>Recent findings: </strong>Life-cycle studies confirm that pMDI emissions are dominated by propellant released during use, whereas DPIs have far lower footprints. New global warming potential (low-GWP) propellants are in advanced development, and the first inhaler using HFO-1234ze(E) has recently been licensed in the UK. Emerging clinical and prescribing data show that optimized therapy, particularly strategies that incorporate low-carbon inhalers, can reduce short-acting beta-agonist (SABA) over-reliance, exacerbations, and per-patient emissions. Guideline-driven, health-system approaches using prescribing data and formulary design can accelerate sustainable, evidence-based inhaler use.</p><p><strong>Summary: </strong>The most immediate path to reducing inhaler-related emissions is to optimize asthma care while prioritizing low-carbon devices where appropriate. As low-GWP pMDIs enter the market, careful planning will be needed to ensure reliable, affordable access to pMDIs is maintained or improved globally, particularly in low- and middle-income countries.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"239-244"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pulmonary fungal infections in the age of biologics and climate change.","authors":"Dora Edith Corzo-Leon","doi":"10.1097/MCP.0000000000001262","DOIUrl":"10.1097/MCP.0000000000001262","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the evolving epidemiology of invasive fungal infections, with emphasis in pulmonary presentations, in the context of climate change and the expanding immunomodulatory therapy use.</p><p><strong>Recent findings: </strong>Fungal infections represent a growing global health threat, with epidemiological patterns increasingly extending beyond traditional immunocompromised populations. Climate-driven thermal adaptation and geographic range expansion of endemic fungi, particularly Coccidioides and Histoplasma species, are exposing immunologically naive populations to infection. The higher use of new biologic therapies (IFNγ inhibitors, immune checkpoint inhibitors, CAR-T cells) is growing cohorts of patients with selective immunosuppression/immunomodulation who exhibit distinct fungal infection susceptibility patterns compared to traditional immunocompromised populations. Additionally, severe respiratory viral pandemics have demonstrated that acute viral pneumonia - independent of underlying immunosuppression - constitutes a significant risk factor for secondary invasive fungal diseases, as evidenced by IAPA and CAPA outbreaks. These shifts are occurring in parallel to increasing azole resistance and rising Pneumocystis pneumonia incidence in non-HIV populations, collectively challenging surveillance strategies, diagnostic algorithms, and therapeutic approaches.</p><p><strong>Summary: </strong>This review synthesizes current evidence on how climate-mediated geographic expansion, biologic-associated immunosuppression, and virus-associated fungal infections are redefining populations at risk for pulmonary fungal infections.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"147-155"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From guidelines to algorithms: the future of AI-augmented asthma care.","authors":"Rachel Culver, Anissa Johnson, Laren Tan","doi":"10.1097/MCP.0000000000001255","DOIUrl":"10.1097/MCP.0000000000001255","url":null,"abstract":"<p><strong>Purpose of review: </strong>Artificial intelligence (AI) has emerged as an increasingly accessible and influential resource within both public and clinical domains. The role of AI in asthma care is expanding; therefore, it must be discussed in the context of evolving management strategies for both clinician and patient.</p><p><strong>Recent findings: </strong>Recent literature demonstrates that AI can integrate evidence-based guidelines with large-scale clinical data to support diagnostic interpretation and therapeutic decision-making in asthma care. Studies have shown that AI platforms can accurately assess asthma symptoms, monitor disease progression, and generate recommendations aimed at reducing exacerbations across diverse clinical scenarios. AI has also demonstrated utility in patient education and self-management support, with variable performance depending on the complexity of clinical inputs and the level of personalization required.</p><p><strong>Summary: </strong>The integration of AI into asthma care offers meaningful opportunities to enhance patient engagement, improve consistency in guideline-based management, and facilitate timely escalation of therapy. For clinicians, AI may serve as a supportive decision-making tool, while for patients, it may provide guidance when healthcare access is limited. Although further validation and oversight are necessary, the increasing use of AI in asthma management has the potential to enhance overall disease control and clinical outcomes.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"232-238"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Update on allergen immunotherapy for asthma.","authors":"R John Looney","doi":"10.1097/MCP.0000000000001259","DOIUrl":"10.1097/MCP.0000000000001259","url":null,"abstract":"<p><strong>Purpose of review: </strong>The usefulness of allergen-specific immunotherapy for asthma is controversial. Publications from 2024 and 2025 on allergen immunotherapy for asthma will be reviewed.</p><p><strong>Recent findings: </strong>A trial of house dust mite for asthma was strikingly positive for a subset of patients with variant alleles in chromosome 17q12-21. A trail of cockroach immunotherapy for asthma was negative based on nasal challenge. However, there were promising effects on T cells. New allergen-specific vaccines using allergoids and adjuvants are being developed in Europe and look promising for reducing the number of injections and improving safety. Small clinical trials have shown that trained immunity vaccines containing bacterial lysates can reduce wheezing in young children and animal models suggest these vaccines can affect allergen sensitization and asthma. Recent reviews of multiple clinical trials have shown allergen-specific immunotherapy can reduce symptoms and medications in asthmatic individuals but not objective measures of lung fucntion. Recent reviews of combining biologics with allergen-immunotherapy suggest improved safety.</p><p><strong>Summary: </strong>Allergen-specific immunotherapy remains an important treatment for allergic rhinitis and conjunctivitis and can be used safely in patients with mild or moderate well controlled asthma. Several new approaches look promising but need a lot more work.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"226-231"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"As-needed inhaled corticosteroids in asthma: from evidence to implementation.","authors":"Eric Merrell, Sandhya Khurana","doi":"10.1097/MCP.0000000000001260","DOIUrl":"10.1097/MCP.0000000000001260","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to clarify the role of as-needed ICS through the severity spectrum of adult asthma and explores the challenges associated with implementation. This review is timely following the recent US Food and Drug Administration (FDA) approval of an ICS/SABA combination inhaler.</p><p><strong>Recent findings: </strong>In 2019, the Global Initiative for Asthma (GINA) recommended against the use of short-acting beta agonist (SABA) monotherapy and officially endorsed the use of as-needed inhaled corticosteroid with a fast-acting bronchodilator [anti-inflammatory reliever (AIR)] as the preferred strategy across all treatment steps. In 2020, the US NHLBI asthma guidelines recommended ICS+SABA at step 2, and ICS/formoterol to be used as maintenance and reliever therapy (MART) at treatment steps 3 and 4. Despite these strong recommendations, uptake of this strategy in the United States has been slow. Barriers to MART implementation are explained, and implementation strategies are reviewed.</p><p><strong>Summary: </strong>Transition to a single ICS/formoterol inhaler as MART from traditional multiinhaler regimens offers the opportunity for multidomain benefits. The role of novel ICS/SABA combination inhalers remains to be determined across the continuum of asthma.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"245-252"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The landscape of aerosol transmission after COVID-19.","authors":"Julian W Tang","doi":"10.1097/MCP.0000000000001263","DOIUrl":"10.1097/MCP.0000000000001263","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review describes how the COVID-19 pandemic stimulated a radical shift around the concepts and definitions of aerosol transmission, and how this new understanding led to a rethink around related infection control interventions that were vital to reduce the spread of SARS-CoV-2, and, potentially, other respiratory viruses.</p><p><strong>Recent findings: </strong>A revision of the terminology for aerosol-transmitted pathogens by the WHO, together with its accompanying open access platform (ARIA), to allow users to define their own exposure scenarios and calculate related transmission risks, are just two of many multidisciplinary collaborations that have paved the way for a more effective pandemic response in the future, for aerosol-transmitted, novel pathogens.</p><p><strong>Summary: </strong>A multipronged approach is needed for any next pandemic, including expertise from laboratory microbiologists and virologists, clinical infectious diseases and infection control teams, public health physicians and epidemiologists, aerosol scientists and engineers. We need to develop a rapid evidence pipeline to collate robust scientific data about any new pathogen, how it is transmitted, how it infects and affects humans, and how to control, treat and prevent it. This article briefly outlines how far we have come and proposes some options to better prepare for the next pandemic.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"182-187"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}