Expert Review of Respiratory Medicine最新文献_第3页

Oscillometry in severe asthma: the state of the art and future perspectives. 严重哮喘的示波测量：技术现状和未来展望。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-07-20 DOI: 10.1080/17476348.2023.2237872

Francesco Menzella, Leonardo Antonicelli, Marcello Cottini, Gianluca Imeri, Lorenzo Corsi, Fabiano Di Marco

{"title":"Oscillometry in severe asthma: the state of the art and future perspectives.","authors":"Francesco Menzella, Leonardo Antonicelli, Marcello Cottini, Gianluca Imeri, Lorenzo Corsi, Fabiano Di Marco","doi":"10.1080/17476348.2023.2237872","DOIUrl":"10.1080/17476348.2023.2237872","url":null,"abstract":"Introduction: Approximately 3-10% of people with asthma have severe asthma (SA). Patients with SA have greater impairment in daily life and much higher costs. Even if asthma affects the entire bronchial tree, small airways have been recognized as the major site of airflow limitation. There are several tools for studying small airway dysfunction (SAD), but certainly the most interesting is oscillometry. Despite several studies, the clinical usefulness of oscillometry in asthma is still in question. This paper aims to provide evidence supporting the use of oscillometry to improve the management of SA in clinical practice.Areas covered: In the ATLANTIS study, SAD was strongly evident across all severity. Various tools are available for evaluation of SAD, and certainly an integrated use of these can provide complete and detailed information. However, the most suitable method is oscillometry, implemented for clinical routine by using either small pressure impulses or small pressure sinusoidal waves.Expert opinion: Oscillometry, despite its different technological implementations is the best tool for determining the impact of SAD on asthma and its control. Oscillometry will also be increasingly useful for choosing the appropriate drug, and there is ample room for a more widespread diffusion in clinical practice.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119423","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}

引用次数: 0

The argument for utilising magnetic resonance imaging as a tool for monitoring lung structure and function in pediatric patients. 利用磁共振成像作为监测儿科患者肺部结构和功能的工具的论点。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-07-28 DOI: 10.1080/17476348.2023.2241355

Brandon Zanette, Mary-Louise C Greer, Theo J Moraes, Felix Ratjen, Giles Santyr

{"title":"The argument for utilising magnetic resonance imaging as a tool for monitoring lung structure and function in pediatric patients.","authors":"Brandon Zanette, Mary-Louise C Greer, Theo J Moraes, Felix Ratjen, Giles Santyr","doi":"10.1080/17476348.2023.2241355","DOIUrl":"10.1080/17476348.2023.2241355","url":null,"abstract":"Introduction: Although historically challenging to perform in the lung, technological advancements have made Magnetic Resonance Imaging (MRI) increasingly applicable for pediatric pulmonary imaging. Furthermore, a wide array of functional imaging techniques has become available that may be leveraged alongside structural imaging for increasingly sensitive biomarkers, or as outcome measures in the evaluation of novel therapies.Areas covered: In this review, recent technical advancements and modern methodologies for structural and functional lung MRI are described. These include ultrashort echo time (UTE) MRI, free-breathing contrast agent-free, functional lung MRI, and hyperpolarized gas MRI, amongst other techniques. Specific examples of the application of these methods in children are provided, principally drawn from recent research in asthma, bronchopulmonary dysplasia, and cystic fibrosis.Expert opinion: Pediatric lung MRI is rapidly growing, and is well poised for clinical utilization, as well as continued research into early disease detection, disease processes, and novel treatments. Structure/function complementarity makes MRI especially attractive as a tool for increased adoption in the evaluation of pediatric lung disease. Looking toward the future, novel technologies, such as low-field MRI and artificial intelligence, mitigate some of the traditional drawbacks of lung MRI and will aid in improving access to MRI in general, potentially spurring increased adoption and demand for pulmonary MRI in children.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10172554","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}

引用次数: 0

Procalcitonin as a biomarker to guide treatments for patients with lower respiratory tract infections. 降钙素原作为指导下呼吸道感染患者治疗的生物标志物。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-28 DOI: 10.1080/17476348.2023.2251394

Ouriel Saura, Charles-Edouard Luyt

{"title":"Procalcitonin as a biomarker to guide treatments for patients with lower respiratory tract infections.","authors":"Ouriel Saura, Charles-Edouard Luyt","doi":"10.1080/17476348.2023.2251394","DOIUrl":"10.1080/17476348.2023.2251394","url":null,"abstract":"Introduction: Lower respiratory tract infections are amongst the main causes for hospital/intensive care unit admissions and antimicrobial prescriptions. In order to reduce antimicrobial pressure, antibiotic administration could be optimized through procalcitonin-based algorithms.Areas covered: In this review, we discuss the performances of procalcitonin for the diagnosis and the management of community-acquired and ventilator-associated pneumonia. We provide up-to-date evidence and deliver clear messages regarding the purpose of procalcitonin to reduce unnecessary antimicrobial exposure.Expert opinion: Antimicrobial pressure and resulting antimicrobial resistances are a major public health issue as well as a daily struggle in the management of patients with severe infectious diseases, especially in intensive care units where antibiotic exposure is high. Procalcitonin-guided antibiotic administration has proven its efficacy in reducing unnecessary antibiotic use in lower respiratory tract infections without excess in mortality, hospital length of stay or disease relapse. Procalcitonin-guided algorithms should be implemented in wards taking care of patients with severe infections. However, procalcitonin performances are different regarding the setting of the infection (community versus hospital-acquired infections) the antibiotic management (start or termination of antibiotic) as well as patient's condition (immunosuppressed or in shock) and we encourage the physicians to be aware of these limitations.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10304051","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}

引用次数: 0

Personalised management and supporting individuals to live with their asthma in a primary care setting. 在初级保健环境中对哮喘患者进行个性化管理和支持。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-03 DOI: 10.1080/17476348.2023.2241357

Hilary Pinnock, Mike Noble, David Lo, Kirstie McClatchey, Viv Marsh, Chi Yan Hui

{"title":"Personalised management and supporting individuals to live with their asthma in a primary care setting.","authors":"Hilary Pinnock, Mike Noble, David Lo, Kirstie McClatchey, Viv Marsh, Chi Yan Hui","doi":"10.1080/17476348.2023.2241357","DOIUrl":"10.1080/17476348.2023.2241357","url":null,"abstract":"Introduction: Complementing recognition of biomedical phenotypes, a primary care approach to asthma care recognizes diversity of disease, health beliefs, and lifestyle at a population and individual level.Areas covered: We review six aspects of personalized care particularly pertinent to primary care management of asthma: personalizing support for individuals living with asthma; targeting asthma care within populations; managing phenotypes of wheezy pre-school children; personalizing management to the individual; meeting individual preferences for provision of asthma care; optimizing digital approaches to enhance personalized care.Expert opinion: In a primary care setting, personalized management and supporting individuals to live with asthma extend beyond the contemporary concepts of biological phenotypes and pharmacological 'treatable traits' to encompass evidence-based tailored support for self-management, and delivery of patient-centered care including motivational interviewing. It extends to how we organize clinical practiceand the choices provided in mode of consultation. Diagnostic uncertainty due to recognition of phenotypes of pre-school wheeze remains a challenge for primary care. Digital health can support personalized management, but there are concerns about increasing inequities. This broad approach reflects the traditionally holistic ethos of primary care ('knowing their patients and understanding their communities'), but the core concepts resonate with all healthcare.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10172580","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}

引用次数: 0

Evaluating as-needed inhaled corticosteroid strategies in asthma: expanding the benefits to mild asthma. 根据需要评估哮喘吸入皮质类固醇策略：将益处扩大到轻度哮喘。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-21 DOI: 10.1080/17476348.2023.2247973

Tommaso Bigoni, Franco Alfano, Federico Baraldi, Marco Contoli, Alberto Papi

{"title":"Evaluating as-needed inhaled corticosteroid strategies in asthma: expanding the benefits to mild asthma.","authors":"Tommaso Bigoni, Franco Alfano, Federico Baraldi, Marco Contoli, Alberto Papi","doi":"10.1080/17476348.2023.2247973","DOIUrl":"10.1080/17476348.2023.2247973","url":null,"abstract":"Introduction: Adherence to regular anti-inflammatory treatment is commonly low, and short-acting β2 agonist (SABA) overuse is common in patients with asthma, leading to an increased risk of asthma-related adverse events.Areas covered: Given the pivotal role of inflammation in asthma, multiple as-needed inhaled corticosteroid (ICS)-containing therapies have been developed, leading to a reduction in asthma exacerbations and improvement in symptom control. Currently, as-needed ICS/formoterol is one of the most commonly available formulations; however, other combinations such as ICS/SABA have been shown to be superior to as-needed SABA alone. Therefore, we performed a comprehensive review of the available scientific literature to enhance the advantages and disadvantages of each combination in clinical practice.Expert opinion: The future direction we foresee in asthma management consists in abandoning as-needed short-acting bronchodilators in favor of as-needed ICS-containing therapies. Each patient is unique and differs from others; consequently, a single option will not fit everyone. Patients' and physicians' awareness of this perspective can be reached through the development of multiple therapeutic options suitable for each condition that can be found in 'real life'.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302092","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}

引用次数: 0

Mechanisms underlying corticosteroid resistance in patients with asthma: a review of current knowledge. 哮喘患者皮质类固醇抵抗的潜在机制：当前知识综述。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-09-04 DOI: 10.1080/17476348.2023.2255124

Javier Milara, Anselm Morell, Inés Roger, Paula Montero, Julio Cortijo

{"title":"Mechanisms underlying corticosteroid resistance in patients with asthma: a review of current knowledge.","authors":"Javier Milara, Anselm Morell, Inés Roger, Paula Montero, Julio Cortijo","doi":"10.1080/17476348.2023.2255124","DOIUrl":"10.1080/17476348.2023.2255124","url":null,"abstract":"Introduction: Corticosteroids are the most cost-effective anti-inflammatory drugs available for the treatment of asthma. Despite their effectiveness, several asthmatic patients have corticosteroid resistance or insensitivity and exhibit a poor response. Corticosteroid insensitivity implies a poor prognosis due to challenges in finding alternative therapeutic options for asthma.Areas covered: In this review, we describe asthma phenotypes and endotypes, as well as their differential responsiveness to corticosteroids. In addition, we describe the mechanism of action of corticosteroids underlying their regulation of the expression of glucocorticoid receptors (GRs) and their anti-inflammatory effects. Furthermore, we summarize the mechanistic evidence underlying corticosteroid-insensitive asthma, which is mainly related to changes in GR gene expression, structure, and post-transcriptional modifications. Finally, various pharmacological strategies designed to reverse corticosteroid insensitivity are discussed.Expert opinion: Corticosteroid insensitivity is influenced by the asthma phenotype, endotype, and severity, and serves as an indication for biological therapy. The molecular mechanisms underlying corticosteroid-insensitive asthma have been used to develop targeted therapeutic strategies. However, the lack of clinical trials prevents the clinical application of these treatments.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305368","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}

引用次数: 0

The value of perioperative physical activity in older patients undergoing surgery for lung cancer. 老年癌症患者围手术期体力活动的价值。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-09-11 DOI: 10.1080/17476348.2023.2255133

Dan J Raz, Jae Y Kim, Loretta Erhunwmunesee, Sherry Hite, Gouri Varatkar, Virginia Sun

{"title":"The value of perioperative physical activity in older patients undergoing surgery for lung cancer.","authors":"Dan J Raz, Jae Y Kim, Loretta Erhunwmunesee, Sherry Hite, Gouri Varatkar, Virginia Sun","doi":"10.1080/17476348.2023.2255133","DOIUrl":"10.1080/17476348.2023.2255133","url":null,"abstract":"Introduction: With a median age at diagnosis of 70, lung cancer represents an enormous public health problem among older Americans. An estimated 19,000 people age 65 and older undergo lung cancer surgery annually in the US. Older adults undergoing lung cancer surgery are often frail with limited physiologic reserves, multi-morbidities, and functional impairments. Physical function, dyspnea, and quality of life return to baseline slower in older adults compared with younger adults after lung surgery.Areas covered: In this review, we summarize available data about perioperative physical activity interventions that may improve outcomes for older adults undergoing lung cancer surgery. We also review the limitations of existing studies and discuss emerging data on the roles of telehealth and family caregiver inclusion in peri-operative physical activity interventions.Expert opinion: We propose that future perioperative physical activity interventions in older adults undergoing lung cancer surgery should include a comprehensive geriatric assessment to guide personalized interventions. Interventions should be conceptually based, with a focus on enhancing self-efficacy, motivation, and adherence through classic behavior change strategies that are proven to impact outcomes. Finally, interventions should be designed with attention to feasibility and scalability. Exercise programs delivered via telehealth (telephone or tele-video) may improve access and convenience for patients.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10357837","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}

引用次数: 0

Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis. 跳出框框思考：囊性纤维化胃肠道症状和并发症综述。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-06-26 DOI: 10.1080/17476348.2023.2228194

Alexander Yule, Darren Sills, Sherie Smith, Robin Spiller, Alan R Smyth

{"title":"Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis.","authors":"Alexander Yule, Darren Sills, Sherie Smith, Robin Spiller, Alan R Smyth","doi":"10.1080/17476348.2023.2228194","DOIUrl":"10.1080/17476348.2023.2228194","url":null,"abstract":"Introduction: Gastrointestinal (GI)-related symptoms, complications, and comorbidities in cystic fibrosis (CF) are common and research to reduce their burden is a priority for the CF community. To enable future research, this review aimed to summarize the range of GI symptoms, complications and comorbidities seen in CF, the underlying pathophysiology, and treatments.Areas covered: This was a rapid systematic review undertaken using the recommendations from the Cochrane Rapid Reviews Methods Group. We searched databases including PubMed, Embase, Medline and the Cochrane database and identified those studies reporting GI-related symptoms, complications, or comorbidities in CF or their treatment. Our searches identified 2,930 studies and a total 119 studies met our inclusion criteria. Where a prevalence could be determined, GI symptoms were reported in 33.7% of study participants. The range of symptoms reported was broad and the highest median prevalence included flatulence (43.5%), bloating and abdominal distension (36%), and fatty stool (36%). Meconium ileus was reported in 12% and distal intestinal obstruction syndrome in 8.5.Expert opinion: GI-related symptoms, complications, and comorbidities in CF are common. More consistent characterization and recording of these symptoms in clinical studies may help achieve the priority of reducing the burden of GI disease in CF.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10489955","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}

引用次数: 0

Diagnosis and management of pulmonary veno-occlusive disease. 肺静脉闭塞性疾病的诊断和治疗。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-21 DOI: 10.1080/17476348.2023.2247989

Sabina Solinas, Athénaïs Boucly, Antoine Beurnier, Mithum Kularatne, Julien Grynblat, Mélanie Eyries, Peter Dorfmüller, Olivier Sitbon, Marc Humbert, David Montani

{"title":"Diagnosis and management of pulmonary veno-occlusive disease.","authors":"Sabina Solinas, Athénaïs Boucly, Antoine Beurnier, Mithum Kularatne, Julien Grynblat, Mélanie Eyries, Peter Dorfmüller, Olivier Sitbon, Marc Humbert, David Montani","doi":"10.1080/17476348.2023.2247989","DOIUrl":"10.1080/17476348.2023.2247989","url":null,"abstract":"Introduction: Pulmonary veno-occlusive disease (PVOD) is an orphan disease and uncommon etiology of pulmonary arterial hypertension (PAH) characterized by substantial small pulmonary vein and capillary involvement.Areas covered: PVOD, also known as 'PAH with features of venous/capillary involvement' in the current ESC/ERS classification.Expert opinion: In recent years, particular risk factors for PVOD have been recognized, including genetic susceptibilities and environmental factors (such as exposure to occupational organic solvents, chemotherapy, and potentially tobacco). The discovery of biallelic mutations in the EIF2AK4 gene as the cause of heritable PVOD has been a breakthrough in understanding the molecular basis of PVOD. Venous and capillary involvement (PVOD-like) has also been reported to be relatively common in connective tissue disease-associated PAH (especially systemic sclerosis), and in rare pulmonary diseases like sarcoidosis and pulmonary Langerhans cell granulomatosis. Although PVOD and pulmonary arterial hypertension (PAH) exhibit similarities, including severe precapillary PH, it is essential to differentiate between them since PVOD has a worse prognosis and requires specific management. Indeed, PVOD patients are characterized by poor response to PAH-approved drugs, which can lead to pulmonary edema and clinical deterioration. Due to the lack of effective treatments, early referral to a lung transplantation center is crucial.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295275","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}

引用次数: 0

Pharmacotherapy for obstructive sleep apnea: targeting specific pathophysiological traits. 阻塞性睡眠呼吸暂停的药物治疗：针对特定的病理生理特征。

IF 3.9 3区医学

Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-30 DOI: 10.1080/17476348.2023.2241353

Elisa Perger, Simona Bertoli, Carolina Lombardi

{"title":"Pharmacotherapy for obstructive sleep apnea: targeting specific pathophysiological traits.","authors":"Elisa Perger, Simona Bertoli, Carolina Lombardi","doi":"10.1080/17476348.2023.2241353","DOIUrl":"10.1080/17476348.2023.2241353","url":null,"abstract":"Introduction: The pathophysiology of obstructive sleep apnea (OSA) is multi-factorial and complex. Varying OSA's pathophysiological traits have been identified, including pharyngeal collapsibility, upper airway muscle reactivity, arousal threshold, and regulation of the ventilatory drive. Being CPAP of difficult tolerance and other interventions reserved to specific subpopulations new pharmacological treatments for OSA might be resolutive.Areas covered: Several existing and newly developed pharmacological drugs can impact one or more endotypes and could therefore be proposed as treatment options for sleep disordered breathing. With this review we will explore different pathophysiological traits as new targets for OSA therapy. This review will summarize the most promising pharmacological treatment for OSA accordingly with their mechanisms of action on upper airway collapsibility, muscle responsiveness, arousal threshold, and loop gain.Expert opinion: Only understanding the pathophysiological traits causing OSA in each patient and placing the disease in the framework of patient comorbidities, we will be able to evolve interventions toward OSA. The development of new drug's combinations will permit different approaches and different choices beside conventional treatments. In the next future, we hope that sleep specialists will select the treatment for a specific patient on the base of its pathophysiology, defining a precision medicine for OSA.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10304063","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}

引用次数: 0