Current Opinion in Pulmonary Medicine最新文献

{"title":"Remote exercise assessment in pulmonary hypertension.","authors":"Paula Appenzeller, Daniel Jeffery, Mark Toshner","doi":"10.1097/MCP.0000000000001277","DOIUrl":"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":"379-385"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13566399/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward precision imaging in interstitial lung disease: advances in quantitative imaging and artificial intelligence.","authors":"Cristina Marrocchio, Michele Ligorio, Nicola Sverzellati","doi":"10.1097/MCP.0000000000001291","DOIUrl":"10.1097/MCP.0000000000001291","url":null,"abstract":"<p><strong>Purpose of review: </strong>To discuss the most recent developments in quantitative imaging and artificial intelligence (AI) applications in interstitial lung diseases (ILD).</p><p><strong>Recent findings: </strong>Aided by technical developments in the field, AI applications in chest imaging are increasingly being investigated, with recent algorithms showing improved performance compared with earlier techniques. This review article discusses the various roles of AI in fibrotic ILD, including diagnosis, characterization, quantification, and prognostication.</p><p><strong>Summary: </strong>Increasing evidence supports the utility of quantitative CT and AI algorithms in improving visual assessment, increasing sensitivity and inter-observer agreement, as well as providing prognostic stratification in patients with a broad range of ILD. Nevertheless, the routine clinical application of these tools remains limited.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"439-447"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13566410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270604","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":"Pragmatic approaches to improve the care of patients with sarcoidosis.","authors":"Elliott D Crouser, John Odackal, Marjolein Drent","doi":"10.1097/MCP.0000000000001296","DOIUrl":"10.1097/MCP.0000000000001296","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sarcoidosis is associated with an increasing global burden, driven by rising prevalence, severe organ involvement, treatment-related morbidity, and substantial impairment in quality of life (QoL). Despite advances in diagnostics and therapeutics, important barriers continue to limit timely, equitable, and patient-centered care. This review highlights three common challenges in sarcoidosis management and outlines pragmatic approaches to address them, using a patient-centered framework that emphasizes whether patients feel better, function better, and are able to thrive.</p><p><strong>Recent findings: </strong>Recent evidence confirms persistent delays in diagnosis, limited access to sarcoidosis expertise, and inequities in referral to specialized care. Growing data indicates that chronic glucocorticoid use contributes substantially to long-term morbidity, supporting glucocorticoid stewardship and earlier use of steroid-sparing therapies. In parallel, patient-reported manifestations, such as fatigue, cognitive dysfunction, dysautonomia, and small fiber neuropathy-related symptoms, are increasingly recognized as major determinants of functional impairment and health-related QoL inadequately captured by traditional objective disease markers. Recent expert recommendations emphasize practical, implementable strategies applicable across both specialist and nonspecialist settings.</p><p><strong>Summary: </strong>Improving sarcoidosis care requires a pragmatic, holistic approach that prioritizes timely diagnosis, equitable access to expertise, minimization of glucocorticoid-related harm, and systematic assessment of patient-reported outcomes. Collectively, these strategies support a patient-centered framework that evaluates treatment success not only by disease control but also by whether patients feel better, function better, and are able to thrive in the context of optimal health, meaningful social connection and contribution. This approach aligns care with patient priorities and supports individualized, shared decision-making.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"500-507"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497233","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":"Low diffusion capacity in pulmonary hypertension.","authors":"Esther J Nossent, Anton Vonk Noordegraaf","doi":"10.1097/MCP.0000000000001290","DOIUrl":"10.1097/MCP.0000000000001290","url":null,"abstract":"<p><strong>Purpose of review: </strong>The diffusion capacity of the lungs for carbon monoxide ( DLCO ) is increasingly recognized as important diagnostic and prognostic marker in pulmonary hypertension. The review summarizes this diagnostic role and provides an overview of the clinical implications, potential underlying pathophysiology and impact of a decreased DLCO in different forms of pulmonary hypertension.</p><p><strong>Recent findings: </strong>When in the diagnostic work-up of pulmonary arterial hypertension (PAH) a strongly lowered DLCO is found one must be aware of other causes and the diagnosis idiopathic PAH should be reconsidered. Left heart disease, lung disease, (peripheral) chronic thrombo-embolic pulmonary hypertension, underlying connective tissue disease and pulmonary veno-occlusive disease belong to the differential diagnosis. If all of these subforms of pulmonary hypertension are excluded and the patient fits the clinical profile the nowadays so called \"Lung phenotype\" should be considered. In general, a severely decreased DLCO is associated with a worse prognosis in different sub forms of pulmonary hypertension.</p><p><strong>Summary: </strong>Reduced DLCO in pulmonary hypertension has important implications for clinical practice and research by improving diagnostic accuracy, supporting patient phenotyping, and identifying high-risk populations. Integration of DLCO into routine pulmonary hypertension assessment, registries, and future studies may enhance disease classification and facilitate more individualized diagnostic and therapeutic strategies.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"372-378"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367440","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 pleural infection.","authors":"Yvette A Yeboah-Kordieh, Diana Mihalache, Udit Chaddha","doi":"10.1097/MCP.0000000000001302","DOIUrl":"https://doi.org/10.1097/MCP.0000000000001302","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review synthesizes recent evidence and provides a stepwise approach to management, emphasizing timely recognition of treatment failure, appropriate escalation of therapy, and individualized decision-making to optimize clinical outcomes.</p><p><strong>Recent findings: </strong>The cornerstone of pleural infection management is appropriate antibiotic therapy and effective pleural drainage. Most infections are polymicrobial, with anaerobic organisms predominating. Image-guided chest tube drainage remains the standard initial intervention. Early recognition of inadequate drainage or persistent pleural infection-related sepsis through close clinical, biochemical, and radiographic assessment is essential to facilitate timely escalation of care. Intrapleural enzyme therapy (IET) reduces the need for surgery, and emerging evidence suggests that lower-dose tissue plasminogen activator (tPA) regimens may preserve efficacy. Current evidence supports a sequential management strategy in which IET precedes surgery, with early thoracic surgical consultation and prompt recognition of IET failure to avoid delays that may increase surgical morbidity.</p><p><strong>Summary: </strong>Successful management of pleural infection depends on early source control, vigilant assessment of treatment response, and timely escalation of care. A structured, stepwise approach that integrates antibiotics and effective pleural drainage, early use of IET when indicated, and prompt surgical consultation for nonresponders offers the best opportunity to improve outcomes while minimizing morbidity.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863917","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":"Factors influencing long-term outcomes in lung transplantation: effective monitoring and comprehensive intervention.","authors":"Junichi Takada, Mitsuaki Kawashima, Masaaki Sato","doi":"10.1097/MCP.0000000000001251","DOIUrl":"10.1097/MCP.0000000000001251","url":null,"abstract":"<p><strong>Purpose of review: </strong>Achieving long-term survival after lung transplantation remains a major challenge. Outcome determinants have expanded beyond pathophysiology to include quality of life and patient-reported outcomes. This review summarizes key prognostic factors associated with outcomes and suggests integrated strategies to improve them.</p><p><strong>Recent findings: </strong>The primary determinants of long-term survival are chronic lung allograft dysfunction (CLAD), infection, and malignancy. Various agents have been investigated for preventing and treating CLAD. Beyond these, managing comorbidities such as renal failure, metabolic disorders, and gastrointestinal dysfunction is crucial. Furthermore, patient-reported outcomes involving both physical and psychosocial aspects (e.g., frailty and sleep disturbance) have emerged as vital prognostic markers. To manage these multifaceted risks, real-time data pipelines (e.g., the Quality in Lung Transplant Initiative) and remote tools including home spirometry facilitate early detection of graft dysfunction. Multidisciplinary interventions, including rehabilitation, adherence support, and artificial intelligence-driven technologies, have shown promise in improving outcomes.</p><p><strong>Summary: </strong>Improving long-term outcomes in lung transplantation requires a comprehensive approach that extends beyond traditional CLAD management. Structured, multicomponent programs integrating data-driven surveillance with multidisciplinary care provide a robust model for early detection and intervention for graft failure and comorbidities, ultimately prolonging survival and quality of life.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"349-358"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118127","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":"Improving lung cancer screening diagnostic efficiency.","authors":"Christopher R Caruso, Roger Y Kim","doi":"10.1097/MCP.0000000000001250","DOIUrl":"10.1097/MCP.0000000000001250","url":null,"abstract":"<p><strong>Purpose of review: </strong>We discuss opportunities to improve lung cancer screening (LCS) diagnostic efficiency, which necessitates simultaneous focus on both diagnosis of early-stage lung cancer and reduction of diagnostic errors during diagnostic evaluation.</p><p><strong>Recent findings: </strong>Recent efforts have focused on three distinct targets for improving LCS diagnostic efficiency: Eligibility and uptake, Adherence to annual screening, and Diagnostic evaluation of concerning findings. There has been ongoing debate regarding who should be screened and how to consider lung cancer risk factors, even as LCS uptake remains suboptimal. LCS annual adherence has emerged as an important quality metric, as it is associated with increased early-stage lung cancer detection. Finally, optimization of the diagnostic pathway once concerning findings are identified via LCS is necessary to minimize exposing those without cancer to the harms of invasive diagnostic testing. Efforts to improve pulmonary nodule risk assessment, the nonmalignant resection rate, and lung cancer overdiagnosis will be crucial.</p><p><strong>Summary: </strong>Improving LCS diagnostic efficiency requires a careful balance between prioritizing lung cancer sensitivity (i.e., ability to diagnose early-stage lung cancers) and avoiding both false negatives (i.e., failure to diagnose an early-stage lung cancer) and false positives (i.e., unnecessary performance of invasive testing for benign lesions).</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"261-269"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124038","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":"Primary prophylaxis and treatment of venous thromboembolism in malignancy with focus on lung cancer: a review of current evidence.","authors":"Felipe Guimaraes Pinto, Danielle Lacava Voltani, Cristhiam M Rojas-Hernandez","doi":"10.1097/MCP.0000000000001265","DOIUrl":"10.1097/MCP.0000000000001265","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cancer-associated thrombosis (CAT) is a significant cause of mortality in oncology, particularly in lung cancer. The clinical management requires a careful balance between preventing venous thromboembolism (VTE) and minimizing bleeding risks. The aim of this review is to provide the latest evidenced based-approach for primary and secondary prevention of CAT.</p><p><strong>Recent findings: </strong>Results from randomized clinical trials, such as TARGET-TP, CASSINI, and AVERT demonstrated that low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) reduce VTE incidence in high-risk ambulatory patients (Khorana score ≥2). Lung-cancer-specific data from FRAGMATIC showed that although VTE risk is halved, there is no overall survival benefit, and routine prophylaxis is not recommended for unselected patients, which aligns with current guidelines. For VTE treatment, randomized trials including CARAVAGGIO, SELECT-D, and ADAM VTE showed that DOACs are non-inferior to LMWH with similar major bleeding rates, although some DOACs increase non-major gastrointestinal or genitourinary bleeding. Invasive approaches such as mechanical thrombectomy and catheter-directed thrombolysis remain reserved for life-threatening presentations.</p><p><strong>Summary: </strong>Pharmacotherapy for prevention of CAT in lung cancer must be individualized. DOACs have emerged as a practical and effective alternative to LMWH for both primary and secondary VTE prophylaxis after assessing risk-benefit.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"306-313"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354124","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":"A practical framework for physicians and researchers to assess diagnostic bronchoscopy technologies in lung cancer.","authors":"David E Ost","doi":"10.1097/MCP.0000000000001271","DOIUrl":"10.1097/MCP.0000000000001271","url":null,"abstract":"<p><strong>Purpose of review: </strong>Advancements in bronchoscopic technologies have improved the diagnosis of peripheral pulmonary nodules, yet inconsistent methodology and outcome definitions in observational studies hinder interpretation and comparison.</p><p><strong>Recent findings: </strong>The American Thoracic Society (ATS) and American College of Chest Physicians (ACCP) have published a Delphi consensus definition of diagnostic yield and reporting standards for diagnostic testing in respiratory medicine. Recognition that bronchoscopy is a multi-disease test has highlighted limitations of traditional dichotomous accuracy metrics.</p><p><strong>Summary: </strong>This review summarizes these methodologic advances and provides a practical framework for clinicians to critically appraise diagnostic bronchoscopy studies, compare technologies, and apply results to individual patients with suspected lung cancer. Emphasis is placed on appropriate reference standards, recognition of bronchoscopy as a multi-disease test, and the superiority of disease specific sensitivity over diagnostic yield for cross-study comparisons.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"300-305"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503371","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":"Robotic-assisted bronchoscopy for lung nodules and masses - can it replace CT-guided transthoracic biopsy?","authors":"Justine Ko, Harmeet Bedi, Jiwoon Chang","doi":"10.1097/MCP.0000000000001270","DOIUrl":"10.1097/MCP.0000000000001270","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic-assisted bronchoscopy is a rapidly evolving tool for the diagnosis of peripheral lung nodules. This review examines literature from the past 18 months, comparing robotic-assisted bronchoscopy's performance with CT-guided transthoracic lung biopsy.Recent findings: Recent studies confirm that robotic-assisted bronchoscopy has a noninferior diagnostic yield and a better safety profile than CT-guided transthoracic lung biopsy. The clinical utility of robotic-assisted bronchoscopy may be further expanded by its compatibility with various biopsy tools, integrated imaging with navigation, capacity for sampling multiple lesions in a single procedure, and ongoing development of associated ablative therapies.</p><p><strong>Summary: </strong>Robotic-assisted bronchoscopy demonstrates a comparable diagnostic yield and a superior safety profile compared to CT-guided transthoracic lung biopsy. The additional features permitted in robotic-assisted bronchoscopy may expand its clinical utility in the future.</p>","PeriodicalId":11090,"journal":{"name":"Current Opinion in Pulmonary Medicine","volume":" ","pages":"278-282"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590731","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}