Current Opinion in Pulmonary Medicine最新文献

{"title":"The effect of mask choice on adherence to positive airway pressure treatment for obstructive sleep apnea in adults.","authors":"Nayla Ahmed, Timothy I Morgenthaler","doi":"10.1097/MCP.0000000000001311","DOIUrl":"10.1097/MCP.0000000000001311","url":null,"abstract":"<p><strong>Purpose of review: </strong>Mask choice is among the few modifiable determinants of positive airway pressure (PAP) effectiveness in adults with obstructive sleep apnea OSA), yet selection is often shaped by convention, habit, or local inventory rather than evidence. We review recent literature, emphasizing studies from the past 18 months and incorporating foundational mechanistic and outcomes studies that should influence prescribing choices.</p><p><strong>Recent findings: </strong>Population-scale telemonitoring analyses confirm that nasal interfaces outperform oronasal masks on adherence, required pressure, residual apnea-hypopnea index (AHI), and unintentional leak. Switching patients from an oronasal to a nasal mask can increase adherence by up to 77%. Drug-induced sleep endoscopy with PAP, cine MRI, and sealed-compartment physiology suggest three main mechanisms for these observations: oral pressure transmission without oral airflow, posterior tongue and mandibular displacement, and increased pharyngeal collapsibility. Mandibular jaw-movement signals allow leak phenotyping that distinguishes mask-seal failure from mouth opening, supporting targeted intervention rather than reflexive interface change.</p><p><strong>Summary: </strong>Current evidence supports a nasal-first prescribing strategy with structured early follow-up using telemonitored adherence, residual AHI, and leak waveform data. Oronasal masks should be reserved for documented and structured nasal-trial failure rather than selected on the basis of self-reported breathing route.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"519-524"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988475","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":"Sleep disorders in patients with HIV.","authors":"Philip B Adebayo, Samina S Somji, Mandela C Makakala","doi":"10.1097/MCP.0000000000001303","DOIUrl":"10.1097/MCP.0000000000001303","url":null,"abstract":"<p><strong>Purpose of review: </strong>The improved survival of people with HIV (PWH) comes with increasing exposure to age-related, metabolic, neuropsychiatric, and cardiovascular risk factors that predispose them to sleep disorders and associated comorbidities. This narrative review examines the current burden, spectrum and causes of sleep disorders in PWH as well as current practice recommendations for their management.</p><p><strong>Recent findings: </strong>Insomnia and sleep apnea and hypopnea syndrome (SAHS) remain the most common sleep disorders in PWH. Although there is paucity of data on the prevalence of circadian rhythm abnormalities and parasomnias, in particular rapid eye movement (REM) sleep behavior disorder (RBD) in PWH, emerging evidence suggests that these disorders abound and deserve further attention regarding their burden, impact and implication for management in PWH. While cognitive behavioral therapy for insomnia (CBT-I) remains the first line management of Insomnia, updated recommendation by AASM allows for the use of CBT-I plus medication in individuals who desire increased sleep time early on in the condition. Continuous positive airway pressure (CPAP) and auto-adjusting PAP (APAP) are preferred modalities of treatment of obstructive sleep apnea. In the same vein, PAP therapies are recommended in patients with CSA. Refractory CSA might benefit from transvenous phrenic nerve stimulation. Gabapentinoids rather than dopamine agonists are now the first line treatment for restless leg syndrome (RLS). Recent recommendation for Iron supplementation lacks HIV specific modification hence, cautious clinical monitoring for Iron overload and symptomatic control of RLS in PWH is suggested.</p><p><strong>Summary: </strong>Current evidence supports the use of guideline-directed interventions. The implication of iron supplementation for RLS in this population deserves future trial.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":"32 6","pages":"543-550"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105684","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":"Advanced imaging in sarcoidosis.","authors":"Madia Ampey, Daniel Steinberger, David Perlman","doi":"10.1097/MCP.0000000000001300","DOIUrl":"10.1097/MCP.0000000000001300","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sarcoidosis remains a challenging disease to diagnose and treat, with a lack of reliable biomarkers to aid in diagnosis and prognosis. Advanced imaging techniques have potential to provide prognostic information and aid in the management of sarcoidosis. Here, we review recent data on the use of these techniques in the assessment and management of sarcoidosis.</p><p><strong>Recent findings: </strong>FDG-PET is increasingly discovering previously occult involvement of sarcoidosis, and a recent expert survey suggests there is little agreement regarding the clinical significance of these findings. Retrospective studies have found associations of some clinical features with FDG-PET findings. FDG activity in pulmonary sarcoidosis may be associated with progression; however, better understanding of the implications of specific imaging features is needed. Liver elastography (ultrasound or MRI) may be a useful tool for identifying hepatic sarcoid patients at risk of progression and for noninvasive disease monitoring.</p><p><strong>Summary: </strong>Advanced imaging techniques such as FDG-PET, MRI, and ultrasound have significant potential to improve outcomes in sarcoidosis patient. However, there remains a lack of data and consensus regarding the role of these techniques in the management of patients with sarcoidosis. More longitudinal cohort data are needed to better apply these advanced imaging techniques in sarcoidosis.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"593-601"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577450","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":"State of the art: practical evaluation and management of tuberculous pleural effusion.","authors":"Ken Ka Pang Chan, Christopher Chan, Pyng Lee","doi":"10.1097/MCP.0000000000001317","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001317","url":null,"abstract":"<p><strong>Purpose of review: </strong>Tuberculous pleuritis (TBP) is one of the most common causes of new-onset pleural effusion, particularly in tuberculosis-endemic regions. This review discusses recent advances in the diagnosis and practical management of TBP, with an emphasis on integrating biomarkers, molecular tests, imaging and pleural tissue sampling into context-specific workflows.</p><p><strong>Recent findings: </strong>The clinical and radiological features of TBP are highly heterogeneous. Certain imaging patterns can help distinguish TBP from other benign or malignant effusions, but they are not fully diagnostic. The diagnostic accuracy of conventional pleural fluid microbiology is limited by the paucibacillary nature of TBP, prompting greater use of pleural biopsy and medical thoracoscopy, which improve microbiological and histological yield. Advanced nucleic acid amplification tests (NAATs), including Xpert MTB/RIF Ultra and emerging sequencing-based assays, have progressively increased sensitivity on pleural fluid, but wider clinical adoption is constrained by incomplete external validation, cost and limited availability. Adenosine deaminase remains the most commonly used pleural fluid biomarker. However, its optimal diagnostic thresholds are highly context-specific and may shift with changing tuberculosis incidence and age distribution. Practical diagnostic workflows now favour flexible use of biomarkers, imaging and pleural tissue sampling to maximize confirmation of TB involvement, while recognizing that patients with probable TBP treated empirically require close follow-up to document treatment response and exclude alternative diseases. Management remains centred on standard anti-tuberculosis regimens, with drainage and other interventions reserved for symptom relief or loculated disease and routine corticosteroid use is not supported by high-quality evidence.</p><p><strong>Summary: </strong>Despite advances in pleural fluid biomarkers, molecular diagnostics and pleural procedures, TBP remains challenging to diagnose reliably. Clinicians should maintain a high index of suspicion for TBP in undiagnosed exudative effusions, especially in endemic regions and adopt locally adapted workflows that combine clinical assessment, biomarkers, NAATs and early pleural tissue sampling when needed.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982076","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":"Practical evaluation and management of symptomatic benign pleural effusions.","authors":"José M Porcel","doi":"10.1097/MCP.0000000000001306","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001306","url":null,"abstract":"<p><strong>Purpose of review: </strong>Benign pleural effusions comprise a heterogeneous group of disorders, but recent advances have been uneven across different etiologies. This review summarizes the developments most likely to influence current clinical practice, focusing on heart failure-related pleural effusions, hepatic hydrothorax, and postcoronary artery bypass graft (CABG) pleural effusions.</p><p><strong>Recent findings: </strong>Heart failure-related pleural effusions have experienced the greatest advances recently. A blood-free pleural fluid triple combination (protein, lactate dehydrogenase, and cholesterol) provides diagnostic accuracy comparable to Light's criteria, while an optimized pleural fluid N-terminal pro-B-type natriuretic peptide (NT-proBNP) threshold of ≥2500 ·mL-1 and the BANCA (Bilateral effusions, Age, NT-proBNP, Cholesterol, and Albumin gradient) score further improve diagnostic confidence. The first randomized trial showed that routine early therapeutic thoracentesis did not improve major 90-day clinical outcomes beyond optimized medical therapy. In hepatic hydrothorax, all patients with refractory disease should undergo early liver transplantation assessment, irrespective of the MELD score, with careful selection for transjugular intrahepatic portosystemic shunt and individualized use of indwelling pleural catheters, while conventional chest tubes should generally be avoided. For post-CABG pleural effusions, recent evidence supports the distinction between uncomplicated postoperative pleural effusions and postpericardiotomy syndrome, as colchicine is only indicated for the latter.</p><p><strong>Summary: </strong>Recent evidence supports replacing the uniform approach to benign pleural effusions with disease-specific diagnostic and therapeutic strategies. Heart failure-related pleural effusions now benefit from integrated diagnostic algorithms, whereas the management of hepatic hydrothorax and post-CABG pleural effusions increasingly emphasizes the treatment of the underlying disease and selective use of pleural interventions.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910958","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":"Multidisciplinary approach in cardiac sarcoidosis: to biopsy or not?","authors":"Ana Pericao, Rakesh Sharma","doi":"10.1097/MCP.0000000000001292","DOIUrl":"10.1097/MCP.0000000000001292","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality, yet its diagnosis remains challenging due to heterogeneous clinical presentations and patchy myocardial involvement. Although endomyocardial biopsy has historically been regarded as the diagnostic gold standard, its limited sensitivity, tendency to provide false negative and inconclusive results and procedural risks have led to increasing reliance on noninvasive imaging. This review assesses the contemporary role of endomyocardial biopsy (EMB) within a multidisciplinary diagnostic framework and evaluates whether tissue diagnosis remains necessary in modern clinical practice.</p><p><strong>Recent findings: </strong>Recent studies highlight the expanding role of cardiac magnetic resonance (CMR) and 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in diagnosing, phenotyping, and risk stratifying CS. Targeted biopsy strategies guided by imaging or electroanatomical mapping have demonstrated improved diagnostic yield compared with random sampling. Multidisciplinary team-based decision-making has emerged as a key determinant in selecting patients for biopsy, particularly when histological confirmation is likely to influence immunosuppressive therapy, device implantation, or prognostic assessment.</p><p><strong>Summary: </strong>EMB retains an important but selective role in CS. Integration of multimodality imaging and multidisciplinary assessment optimizes patient selection, enhances procedural safety, and ensures that biopsy findings meaningfully inform management. Future research should refine biopsy indications and integrate imaging with molecular and biomarker-based approaches to improve diagnostic accuracy and prognostication.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"471-481"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374969","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":"Current hot topics in pulmonary hypertension.","authors":"Katarina Zeder, Gabor Kovacs","doi":"10.1097/MCP.0000000000001289","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001289","url":null,"abstract":"","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":"32 5","pages":"363-364"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663564","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":"Genetic variants in pulmonary hypertension associated with chronic obstructive pulmonary disease.","authors":"Vasile Foris, Michael H Cho, Adel Boueiz","doi":"10.1097/MCP.0000000000001275","DOIUrl":"10.1097/MCP.0000000000001275","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize emerging evidence supporting genetic susceptibility to pulmonary vascular phenotypes in chronic obstructive pulmonary disease (COPD) and to provide a rationale for focused genomic investigation of pulmonary hypertension associated with COPD (PH-COPD).</p><p><strong>Recent findings: </strong>Multiancestry genome-wide association studies and integrative genomic analyses have identified COPD risk loci involved in pathways related to lung development, extracellular matrix remodeling, angiogenesis, immune signaling, and hypoxia responses, processes that intersect with pulmonary vascular biology. Concurrent advances in pulmonary arterial hypertension (PAH) genetics demonstrate that rare pathogenic variants in developmental and endothelial signaling genes produce vascular phenotypes often accompanied by reduced diffusing capacity, parenchymal abnormalities, and proliferative vasculopathy. Consistent with these observations, data from independent PAH cohorts reveal phenotypic overlap and biological heterogeneity between group 1 and group 3 classifications. Collectively, these findings suggest that a subset of COPD patients with pulmonary hypertension may harbor unrecognized genetic susceptibility influencing pulmonary vascular remodeling. However, dedicated genetic studies specifically examining PH-COPD remain limited.</p><p><strong>Summary: </strong>PH-COPD may represent, in part, a genetically influenced disease that extends beyond the traditional PH group boundaries. Systematic genomic sequencing coupled with clinical, imaging, and physiological phenotyping will be essential to identify biologically defined subgroups and guide precision therapeutic strategies.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"394-401"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765282","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":"Preclinical and clinical advances in pulmonary hypertension associated with systemic sclerosis.","authors":"Anna Birnhuber, Katarina Zeder, Grazyna Kwapiszewska","doi":"10.1097/MCP.0000000000001284","DOIUrl":"10.1097/MCP.0000000000001284","url":null,"abstract":"<p><strong>Purpose of review: </strong>Systemic sclerosis (SSc) is a chronic, severe autoimmune disease characterized by progressive fibrosis of the skin and internal organs. Pulmonary (arterial) hypertension (P(A)H) is a common complication and leading cause of death. This review highlights preclinical and clinical advances of recent years that contribute to our understanding of pathomechanisms, risk stratification, treatment and potential targets in SSc-P(A)H.</p><p><strong>Recent findings: </strong>As SSc-PH emerges from a complex interplay of immune dysregulation, endothelial injury, metabolic reprogramming and fibroproliferative remodeling, an integrated approach to early detection, combining refined cardiac imaging metrics, circulating and omics-based biomarkers, and clinical stratifiers such as age and timing of symptom onset, is increasingly feasible. Recent literature highlights mechanistic targets for therapy and also practical tools for sharpening screening algorithms to reduce unnecessary right heart catheterization. Exercise testing and detailed right heart phenotyping yield promise for early disease diagnosis. Four randomized controlled trials in PAH provide (indirect) evidence on efficacy and safety of activin signaling inhibitor, Sotatercept in SSc-PAH.</p><p><strong>Summary: </strong>Recent years have brought major preclinical and clinical advances improving diagnosis and management of SSc-P(A)H. Large-scale multi-omics analyses, and novel treatment targets offer further advances in the field.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"424-431"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210502","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":"Current understanding of environmental exposures and sarcoidosis.","authors":"Mark B Mallozzi, Lisa A Maier, Nancy W Lin","doi":"10.1097/MCP.0000000000001294","DOIUrl":"10.1097/MCP.0000000000001294","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sarcoidosis is a heterogeneous disease with unknown etiology. The role of exposures in sarcoidosis is incompletely understood. Gene-environment interactions are likely an important aspect of sarcoidosis etiology and phenotypes. This review critically evaluates the current literature regarding the role of environmental factors in sarcoidosis.</p><p><strong>Recent findings: </strong>Environmental factors are likely a key aspect of the pathophysiology of sarcoidosis; identifying these factors is an important and active part of sarcoidosis research, with implications for early identification and potentially prevention of disease. Bioaerosols have previously been associated with sarcoidosis risk. More recent and ongoing research suggests a possible role of inorganic exposures in both the etiology and progression of sarcoidosis. The identification of multiple exposures across different sarcoidosis manifestations suggests a possible gene-environment-phenotype relationship, which may explain some of the difficulty with identifying specific causes to date.</p><p><strong>Summary: </strong>Several environmental exposures are associated with a risk for sarcoidosis, but their exact role is incompletely understood. Further understanding of the environmental factors that influence sarcoidosis may provide an important opportunity for intervention.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"482-490"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497267","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}