Current Opinion in Pulmonary Medicine最新文献

{"title":"An update on sleep disordered breathing in spinal cord injury.","authors":"David J Berlowitz, Marnie Graco","doi":"10.1097/MCP.0000000000001207","DOIUrl":"10.1097/MCP.0000000000001207","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sleep disordered breathing (SDB) is a direct consequence of tetraplegic spinal cord injury (SCI), is highly prevalent in both tetraplegia and paraplegia, and is associated with worse daytime functioning and reduced quality of life. Despite this, most people with SCI are undiagnosed and untreated for the disorder. This narrative review summarises research from the last 5 years on the epidemiology, pathophysiology, and consequences of SDB in SCI, as well as the current approaches to screening, diagnosis, and treatment of SDB in this population.</p><p><strong>Recent findings: </strong>Previous research predominantly focussed on SDB in tetraplegia, however recent studies have established that people with paraplegia also experience substantially higher prevalence than the general population. SDB risk screening questionnaires are not helpful because SDB in SCI is so prevalent, and questionnaires alone cannot exclude true negative cases. Alternative treatments, such as mandibular advancement devices, are feasible and likely effective, and alternative care models may improve rates of diagnosis and access to treatments.</p><p><strong>Summary: </strong>Recent research into SDB in SCI has identified novel, emergent themes, however researchers must collaborate more to achieve sample sizes that can deliver impact in this relatively rare population.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"584-590"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946167","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":"Challenges and opportunities for drug development in rare pulmonary diseases like cystic fibrosis: an industry perspective.","authors":"Zachary M Sellers, Alan H Cohen","doi":"10.1097/MCP.0000000000001218","DOIUrl":"10.1097/MCP.0000000000001218","url":null,"abstract":"<p><strong>Purpose of review: </strong>There is a critical need for new therapies addressing the high unmet needs of individuals with rare lung diseases. This review examines the challenges industry sponsors face in developing therapeutic products for rare lung diseases, using cystic fibrosis as an example.</p><p><strong>Recent findings: </strong>Since the development of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the drug development landscape for cystic fibrosis has changed. New challenges include defining success in an era of small molecule CFTR modulators, recruitment from a small, ultra-rare population, limited experience with novel trial designs and biomarkers, and fluctuations in funding opportunities.</p><p><strong>Summary: </strong>While challenges to drug development in rare lung disease, including cystic fibrosis, these challenges also present opportunities for innovation amongst industry sponsors, researchers, foundations/advocacy groups, regulators, and funders. Through collaborative partnerships, we can achieve our collective goal of improving the quality and length of lives of those suffering from rare lung diseases.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"658-665"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014125","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":"Does glucose metabolism and its consequences depend on the phenotype of obstructive sleep apnea?","authors":"Akeruetai Suwannakin, Sirimon Reutrakul, Naricha Chirakalwasan","doi":"10.1097/MCP.0000000000001206","DOIUrl":"10.1097/MCP.0000000000001206","url":null,"abstract":"<p><strong>Purpose of review: </strong>Obstructive sleep apnea (OSA) is a common form of sleep-disordered breathing, with rising prevalence and increasingly recognized for its association with multisystem involvement, particularly abnormalities in glucose metabolism. This review examined the relationship between OSA and glucose metabolism and associated cardiovascular outcomes.</p><p><strong>Recent findings: </strong>OSA is a significant risk factor for the development of abnormal glucose metabolism and is strongly associated with incident cardiovascular disease, partly mediated by impaired glucose regulation. Emerging evidence highlights a bidirectional relationship between OSA and glucose dysregulation, including insulin resistance and type 2 diabetes. Specific OSA phenotypes such as rapid eye movement (REM)-related OSA and marked nocturnal desaturation have been associated with worsened glycemic control. However, current data show inconsistent improvements in glucose homeostasis following continuous positive airway pressure (CPAP) therapy, indicating the need for more targeted approaches. Meanwhile, weight loss by lifestyle modification, bariatric surgery or medications have been shown to improve OSA as well as glycemic control in people with diabetes.</p><p><strong>Summary: </strong>Personalized strategies targeting specific OSA phenotypes may improve metabolic outcomes in patients with coexisting glucose dysregulation. Integrating metabolic biomarkers into clinical practice could enable earlier detection of maladaptive changes and support precision-guided interventions to improve long-term outcomes.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"577-583"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844840","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":"The rapidly changing paradigms for the diagnosis and treatment of cystic fibrosis, bronchiectasis, and primary ciliary dyskinesia.","authors":"Mark L Metersky, Douglas J Conrad, Adam J Shapiro","doi":"10.1097/MCP.0000000000001216","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001216","url":null,"abstract":"","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":"31 6","pages":"620-621"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205884","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":"Small fibre neuropathy and sarcoidosis, target for diagnosis and treatment?","authors":"Christopher P Atkins","doi":"10.1097/MCP.0000000000001191","DOIUrl":"10.1097/MCP.0000000000001191","url":null,"abstract":"<p><strong>Purpose of review: </strong>To update the reader on recent evidence relating to symptoms, diagnostic strategies and management options for small-fibre neuropathy (SFN) in sarcoidosis. Learning points from recent studies are presented in the context of previous research forming the basis of our knowledge of SFN in patients with sarcoidosis.</p><p><strong>Recent findings: </strong>Recent studies have shown overlap of SFN and other symptoms beyond pain in patients with sarcoidosis. Where SFN exists, determining the optimal diagnostic modalities is challenging; there have been developments in how forms of temperature threshold testing should be performed, as well as whether this test may miss patchy involvement by SFN in sarcoidosis. To aid identification of SFN in sarcoidosis, questionnaires has been developed specifically looking at sarcoidosis-associated SFN, attempting to capture the patients with patchy or intermittent SFN symptoms. Standard systemic management for sarcoidosis is ineffective for SFN, though infliximab shows promise and is increasingly being utilised as a treatment option.</p><p><strong>Summary: </strong>Few studies have been published in the last two years but there have been developments that have progressed our knowledge. This review collates the latest research alongside prior work, aiming to help summarise diagnosis and management strategies for this problematic manifestation of sarcoidosis.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"547-551"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574946","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":"Lung ultrasound as a screening tool for interstitial lung disease in patients with rheumatoid arthritis: state of the art.","authors":"Maria Otaola, Jesper R Davidsen","doi":"10.1097/MCP.0000000000001200","DOIUrl":"10.1097/MCP.0000000000001200","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review describes the properties and examines available evidence supporting LUS as a screening tool for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). ILD is a common and serious complication of RA, associated with high mortality rates, especially when diagnosed late. Despite its high prevalence and significant prognostic impact, the need for and approach to systematic screening for lung involvement in RA remain unclear and are not recommended in current guidelines. While high-resolution computed tomography (HRCT) is the gold standard for diagnosing ILD, it cannot be frequently repeated due to limitations in the availability, cost, and radiation exposure.</p><p><strong>Recent findings: </strong>Lung ultrasound (LUS) has emerged as a potential noninvasive, accurate, low-cost, and nonionizing alternative for detecting ILD, offering high sensitivity and negative-predictive value (NPV) compared to HRCT. Key LUS findings indicative of ILD include B-line artefacts (BLA) and pleural irregularity. Evidence supporting the performance and applicability of LUS in diagnosing RA-ILD continues to grow.</p><p><strong>Summary: </strong>LUS has shown a good performance in ILD detection. Further research and standardization efforts are needed to fully integrate LUS into routine RA screening protocols.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"476-483"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607720","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":"Precision medicine in rheumatoid arthritis-associated interstitial lung disease: current evidence and future directions.","authors":"Scott M Matson","doi":"10.1097/MCP.0000000000001190","DOIUrl":"10.1097/MCP.0000000000001190","url":null,"abstract":"<p><strong>Purpose of review: </strong>Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) leads to poor survival, on average only 3-5 years from time of diagnosis. Despite its clinical impact, evidence-based treatment approaches remain limited, creating urgent clinical uncertainty about optimal management strategies. This review examines emerging precision medicine approaches that may guide more effective, individualized treatment decisions.</p><p><strong>Recent findings: </strong>Current treatment paradigms based on radiologic patterns lack empirical validation, with recent evidence suggesting radiologic features poorly predict immunomodulatory response. Advances in RA joint precision medicine using synovial biopsy and RNA sequencing have identified molecular endotypes predicting differential treatment response, establishing a framework that could be applied to RA-ILD. Emerging biomarkers including leukocyte telomere length, circulating proteomics, and lung-based systems biology show promise for identifying RA-ILD molecular heterogeneity and guiding treatment selection.</p><p><strong>Summary: </strong>Progress in RA-ILD precision medicine requires multimodal approaches integrating molecular phenotyping with targeted therapeutic trials. Lessons from RA joint precision medicine suggest accessing the disease compartment directly through bronchoscopy may provide crucial information beyond peripheral biomarkers. Prospective biomarker-stratified trials are urgently needed to overcome clinical equipoise and improve outcomes for this challenging condition.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"518-525"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474205","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":"Current concepts in the pathogenesis and clinical management of lymphangioleiomyomatosis.","authors":"Donal O'Malley, Nishant Gupta, Cormac McCarthy","doi":"10.1097/MCP.0000000000001185","DOIUrl":"10.1097/MCP.0000000000001185","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lymphangioleiomyomatosis (LAM) is a systemic, low-grade, metastasizing neoplasm that predominantly affects women. This review demonstrates recent progression in this rare disease, from improved understanding of pathogenesis, to novel treatments. We provide an overview of recent advances that are shaping the future of LAM diagnostic and treatment approaches.</p><p><strong>Recent findings: </strong>Understanding the role of hormonal pathways, immune system interactions, mechanistic target of rapamycin (mTOR) signalling inhibition and the LAM microenvironment is creating opportunities for combination therapies with curative potential. Evidence supporting the uterine origin of LAM cells has renewed interest in hormonal signalling pathways, while potential immune evasion mechanisms of LAM cells are under investigation. More complete blockade of mTOR pathways by newer generation agents, as well as research into the crosstalk between LAM cells and their surroundings is informing development of novel combination therapies with disease modifying potential. Biomarker identification beyond vascular endothelial growth factor D (VEGF-D) is essential for diagnostic, prognostic and treatment decision making. Cellular mapping using single-cell RNA sequencing and spatial transcriptomics, as well as integration of artificial intelligence into diagnostic and therapeutic development pathways, has the potential to significantly advance our understanding of this rare disease.</p><p><strong>Summary: </strong>LAM research demonstrates how sustained investigation in rare disease can advance from preclinical mechanistic insights to targeted treatments. Understanding the role of hormonal pathways, immune system interactions, mTOR signalling inhibition and the microenvironment is creating opportunities for combination therapies with curative potential. Advancements in technology, including single cell analysis, spatial transcriptomics and artificial intelligence are accelerating the discover of biomarkers and therapeutic targets, positioning LAM for significant clinical advances in the coming years.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"494-503"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274402","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":"Rare pulmonary diseases and pulmonary hypertension.","authors":"Federico Tagariello, Davide Elia, Sergio Alfonso Harari","doi":"10.1097/MCP.0000000000001188","DOIUrl":"10.1097/MCP.0000000000001188","url":null,"abstract":"<p><strong>Purpose of review: </strong>Pulmonary hypertension (PH) is a significant complication of various lung diseases, including rare conditions such as lymphangioleiomyomatosis (LAM) and pulmonary Langerhans cell histiocytosis (PLCH). This review explores the pathophysiology, diagnostic challenges, and therapeutic strategies for managing PH in these conditions, emphasizing recent findings and gaps in knowledge.</p><p><strong>Recent findings: </strong>In LAM, PH primarily results from parenchymal destruction and hypoxic vasoconstriction rather than direct vascular involvement, leading to its reclassification from Group 5 to Group 3 PH. Sirolimus, an mTOR inhibitor, has demonstrated benefits in stabilizing lung function and may indirectly reduce pulmonary pressures, though direct effects remain unproven. In PLCH, PH is often disproportionate to lung function impairment, suggesting a distinct pulmonary vasculopathy. Histopathologic studies reveal extensive vascular remodeling, including features of pulmonary veno-occlusive disease. Case reports suggest potential benefits of PH-specific therapies such as endothelin receptor antagonists and phosphodiesterase-5 inhibitors, but their use requires caution due to the risk of worsening gas exchange.</p><p><strong>Summary: </strong>PH in LAM and PLCH is uncommon but clinically relevant, particularly in advanced disease. While emerging therapies show promise, further research is needed to optimize management and improve patient outcomes.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"470-475"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505081","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":"Evolving management of sarcoidosis in the real world.","authors":"Daniel A Culver, Manuel L Ribeiro Neto","doi":"10.1097/MCP.0000000000001204","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001204","url":null,"abstract":"<p><strong>Purpose of review: </strong>The management of sarcoidosis has relied mainly on glucocorticoids for over 80 years. Innumerable review articles, as well as all current guidelines, position systemic steroids as first line therapy for moderate and severe sarcoidosis. Despite accumulating evidence of short term (mostly overt) and long term (often unrecognized) toxicities of steroids, and the example of specialists treating diseases like rheumatoid arthritis and inflammatory bowel disease, the treatment paradigm for sarcoidosis has remained stubbornly affixed to steroids.</p><p><strong>Recent findings: </strong>In 2025, there is now compelling evidence to relegate steroids to a lesser role in the management of sarcoidosis. Nonsteroid agents, especially methotrexate, can be used as first line therapy for many patients.</p><p><strong>Summary: </strong>As steroid use diminishes, the development and implementation of additional steroid-sparing agents will assume increased importance.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":"31 5","pages":"552-559"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788520","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}