European Respiratory Review最新文献

{"title":"Risk factors for drug-resistant pathogens in community-acquired pneumonia: systematic review and meta-analysis.","authors":"Natsuki Nakagawa, Masahiro Katsurada, Yosuke Fukuda, Shingo Noguchi, Nobuyuki Horita, Makoto Miki, Hiroki Tsukada, Kazuyoshi Senda, Yuichiro Shindo, Hiroshi Mukae","doi":"10.1183/16000617.0183-2024","DOIUrl":"10.1183/16000617.0183-2024","url":null,"abstract":"<p><strong>Introduction: </strong>Community-acquired pneumonia (CAP) is a leading cause of death worldwide. Reducing inappropriate and excessive use of extended-spectrum antibiotics is essential for treating CAP effectively. Evaluating the risk of drug-resistant pathogens (DRPs) is crucial for determining initial antibiotic therapy in clinical settings.</p><p><strong>Methods: </strong>This systematic review and meta-analysis assessed the risk factors for DRPs in patients with CAP. CAP-DRPs were defined as pathogens resistant to commonly used antibiotics for CAP, including nonpseudomonal β-lactams such as ceftriaxone or sulbactam-ampicillin, macrolides and respiratory fluoroquinolones. The studies included were divided into two cohorts, namely an all-patient cohort, comprising both culture-positive and culture-negative patients, and a culture-positive pneumonia cohort, comprising patients with identified causative pathogens. The primary objective of this study was to evaluate the risk factors for CAP-DRPs in the all-patient cohort.</p><p><strong>Results: </strong>24 articles were included with 11 categorised into the all-patient cohort. The meta-analysis identified 11 significant risk factors for CAP-DRPs, namely prior DRP infection/colonisation, tracheostomy, severe respiratory failure requiring early induction of mechanical ventilation, prior use of antibiotics, chronic lung disease, COPD, wound care, neurological disorders, prior hospitalisation, nursing home residence and low activities of daily living.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first systematic review focused on CAP-DRP. Unlike previous reviews, the all-patient and culture-positive pneumonia cohorts were analysed separately. Findings from the all-patient cohort are particularly relevant for guiding initial antimicrobial selection in clinical practice. Furthermore, the abovementioned factors should be considered when developing prediction models for CAP-DRPs.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interplay between respiratory viruses and cilia in the airways.","authors":"Katie Horton, Peter A C Wing, Claire L Jackson, Christopher J McCormick, Mary P Carroll, Jane S Lucas","doi":"10.1183/16000617.0224-2024","DOIUrl":"10.1183/16000617.0224-2024","url":null,"abstract":"<p><p>The airway epithelium is the first point of contact for inhaled pathogens. The role of epithelial cells in clearance, infection and colonisation of bacteria is established. The interactions of respiratory viruses and cilia is less understood, but viruses are known to target ciliated epithelial cells for entry, replication and dissemination. Furthermore, some respiratory viruses impair and/or enhance ciliary activity. This review examines what is known about the interactions between cilia and viral infection and how respiratory viruses effect cilia function with subsequent consequences for human health. We discuss the models which can be used to investigate the relationship between respiratory viruses and the host airway.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of heat shock protein 90 in idiopathic pulmonary fibrosis: state of the art.","authors":"Giorgio Monteleone, Paolo Cameli, Francesco Bonella","doi":"10.1183/16000617.0147-2024","DOIUrl":"10.1183/16000617.0147-2024","url":null,"abstract":"<p><p>Heat shock protein 90 (HSP 90) and its isoforms are a group of homodimeric proteins that regulate several cellular processes, such as the elimination of misfolded proteins, cell development and post-translational modifications of kinase proteins and receptors. Due to its involvement in extracellular matrix (ECM) remodelling, myofibroblast differentiation and apoptosis, HSP 90 has been investigated as a key player in the pathogenesis of lung fibrosis. Idiopathic pulmonary fibrosis (IPF) is the most common and deadly interstitial lung disease, due to the progressive distortion of lung parenchyma related to the overproduction and deposition of altered ECM, driven by transforming growth factor-β (TGF-β) dependent and independent pathways. The inhibition or induction of HSP 90 is associated with a reduced or increased expression of TGF-β receptors, respectively, suggesting a role for HSP 90 as a biomarker and therapeutic target in IPF. Experimental drugs such as geldanamycin and its derivatives 17-AAG (17-<i>N</i>-allylamino-17-demethoxygeldanamicin) and 17-DMAG (17-dimethylaminoethylamino-17-demethoxigeldanamycin), along with AUY-922, 1G6-D7, AT-13387, TAS-116 and myricetin, have been found to reduce lung fibrosis in both <i>in vivo</i> and <i>in vitro</i> models, supporting the role of this emerging target. This review aims to illustrate the structure and biological function of HSP 90 in the context of IPF pathobiology, as well as perspective application of this molecule as a biomarker and therapeutic target for IPF.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidities in the idiopathic pulmonary fibrosis and progressive pulmonary fibrosis trial population: a systematic review and meta-analysis.","authors":"Tyson M Walters, Marcus C H Leong, Sydney B Montesi, Christopher J Ryerson, Yet H Khor","doi":"10.1183/16000617.0238-2024","DOIUrl":"10.1183/16000617.0238-2024","url":null,"abstract":"<p><strong>Background: </strong>Comorbidities can affect drug tolerability and health outcomes in patients with fibrotic interstitial lung disease. This systematic review and meta-analysis evaluated the types and prevalence of comorbidities amongst participants in pharmaceutical randomised controlled trials (RCTs) of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF).</p><p><strong>Methods: </strong>Ovid Medline, Embase and CENTRAL databases were searched to identify phase II and III pharmaceutical RCTs of IPF or PPF. Reporting of comorbidities was evaluated, with meta-analyses being performed for the prevalence of different conditions.</p><p><strong>Results: </strong>34 articles were included, with 23 unique trials for IPF and one for PPF. A mean of 14 (range 1-44) comorbidities per study was reported in the IPF RCTs, with 11 being reported in the PPF RCT. Common comorbidities in the IPF RCT cohorts were systemic hypertension (pooled prevalence 45%, 95% CI 39-50%), hyperlipidaemia (38%, 95% CI 27-49%), gastro-oesophageal reflux disease (45%, 95% CI 36-54%), ischaemic heart disease (18%, 95% CI 13-42%) and diabetes mellitus (16%, 95% CI 13-20%). The PPF trial cohort had similar types and prevalence of comorbidities to those reported in the IPF trial cohorts.</p><p><strong>Conclusions: </strong>Reporting of comorbidities varied across previous IPF RCTs, with limited data available for PPF. Prevalence of comorbidities reported in the IPF and PPF trial cohorts appear to be lower than those reported in prospective patient registries. There is a need for careful consideration of trial eligibility criteria with detailed reporting of comorbidities in future pharmaceutical RCTs to better understand the applicability of trial findings to real-world patients.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote monitoring in asthma: a systematic review.","authors":"Giselle Mosnaim, Michelle Carrasquel, Tatum Ewing, Alba Berty, Madeline Snedden","doi":"10.1183/16000617.0143-2024","DOIUrl":"10.1183/16000617.0143-2024","url":null,"abstract":"<p><strong>Background: </strong>Poor adherence to maintenance inhalers and incorrect maintenance and reliever inhaler technique are associated with poor asthma outcomes. Remote therapeutic monitoring and remote patient monitoring support asthma guideline recommendations to regularly review adherence and inhaler technique, with the ultimate goal to improve asthma outcomes.</p><p><strong>Objective: </strong>This work systematically reviewed all clinical trials testing remote monitoring interventions on asthma outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, SCOPUS, Ovid, CINAHL and reference review databases was conducted from 1 January 2000 to 30 April 2024. Articles were included if the title or abstract included MeSH terms of \"nebulizers and vaporizers\" in combination with \"digital\", \"remote\", \"electronic\" or \"smart inhaler\" to identify interventional studies testing remote monitoring for asthma. We characterised populations, interventions, control groups, outcomes, timeframe and setting across studies.</p><p><strong>Results: </strong>Of 2043 articles reviewed, 19 articles met the inclusion criteria (n=14 remote therapeutic monitoring; n=5 remote patient monitoring). While a wide range of outcomes were measured across studies, overall, the studies (n=19) that met the inclusion criteria demonstrated a slower decline in maintenance inhaler adherence (n=13), decreased reliever use (n=6) and improvements in asthma control (n=3). They did not demonstrate positive outcomes on asthma exacerbations and healthcare utilisation, but this may be due to study sample sizes, eligibility criteria and duration.</p><p><strong>Conclusion: </strong>Remote monitoring demonstrates improvements in important intermediary asthma outcomes. Future studies with larger sample sizes, duration and requiring greater disease severity as eligibility criteria are warranted to evaluate their efficacy at decreasing asthma-related oral steroid use, emergency department visits, hospitalisations and costs.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-centred outcomes in severe asthma: fatigue, sleep, physical activity and work.","authors":"Lianne Ten Have, Fleur L Meulmeester, Kim de Jong, Anneke Ten Brinke","doi":"10.1183/16000617.0122-2024","DOIUrl":"10.1183/16000617.0122-2024","url":null,"abstract":"<p><p>Severe asthma places a significant burden on patients, with recent research revealing overlooked patient needs extending beyond physical symptoms. To optimise the patient-centred approach to managing severe asthma, it is crucial to deepen our understanding of these needs. This review examines the prevalence and impact of four prioritised patient needs in severe asthma, namely fatigue, sleep disturbances, physical inactivity and reduced presence and productivity at work. It explores how these factors relate to classic asthma outcomes and quality of life, and the potential impact of interventions. Fatigue affects up to 90% of patients, while sleep difficulties impact 70-75% of severe cases, contributing to impaired daily function and quality of life. Although both are linked to asthma control, the cause-and-effect relationship remains unclear, making it clinically intriguing to investigate whether interventions targeting fatigue or sleep problems affect asthma control. In asthma patients, physical inactivity occurs both as consequence and contributing factor to uncontrolled disease. Interventions promoting physical activity improve asthma control and quality of life, suggesting a potential role in severe asthma management. Finally, work productivity loss, notably present in severe asthma cases, strongly correlates with asthma control and exacerbations. While biologic therapies show potential to reverse this loss, their effects on physical activity, fatigue and sleep disturbances warrant further investigation. Nonpharmacological interventions targeting these needs, such as pulmonary rehabilitation and behavioural therapies, may provide opportunities to enhance patients' well-being. Overall, this review highlights significant gaps in understanding patient-centred aspects of severe asthma, urging for research on comprehensive interventions to improve patients' lives.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supplemental oxygen for symptomatic relief in people with serious respiratory illness: a systematic review and meta-analysis.","authors":"Zainab Ahmadi, Natasha E Smallwood, Anne-Marie Russell, Ravijyot Saggu, Lorena Romero, Anne E Holland, Magnus Ekström","doi":"10.1183/16000617.0025-2024","DOIUrl":"10.1183/16000617.0025-2024","url":null,"abstract":"<p><strong>Background: </strong>People with serious respiratory illness frequently have a high symptom burden and may be prescribed supplemental oxygen therapy with the aims of reducing the severity of breathlessness and improving health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to assess the effectiveness of oxygen therapy <i>versus</i> no oxygen on 1) breathlessness, 2) HRQoL and 3) adverse events.</p><p><strong>Methods: </strong>A comprehensive search was performed in Embase, Medline and the Cochrane Central Register of Controlled Trials for randomised controlled trials published prior to June 2022. We used the Cochrane Risk of Bias Tool for appraising the studies and conducted random-effect meta-analyses when appropriate. We pooled effects recorded on different scales as standardised mean differences (SMDs) with 95% confidence intervals. Lower SMDs indicated decreased breathlessness or HRQoL. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework.</p><p><strong>Results: </strong>We found that supplemental oxygen (compared with sham air or no treatment), reduced breathlessness intensity during laboratory exercise testing (SMD -0.75, 95% CI -1.23--0.28, 12 randomised control trials (RCTs), 245 participants), but had no shown effect on breathlessness measured in daily life (SMD -0.08, 95% CI -0.41-0.26, one RCT, 213 participants) or HRQoL (SMD -0.06, -0.17-0.05, 14 RCTs, 1062 participants). Few or no adverse events related to oxygen therapy were reported. For all the outcomes, the certainty of evidence was low.</p><p><strong>Conclusions: </strong>Oxygen improved exertional breathlessness in laboratory-based exercise studies but was not shown to improve breathlessness or HRQoL in daily life.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of diversity in antifibrotic trials for pulmonary fibrosis: a systematic review.","authors":"Amy Pascoe, Xinye Esther Chen, Natasha Smallwood","doi":"10.1183/16000617.0201-2024","DOIUrl":"10.1183/16000617.0201-2024","url":null,"abstract":"<p><strong>Introduction: </strong>Social determinants of health (SDH), including age, sex, ethnicity, socioeconomic status and rurality, influence health outcomes. Clinical trials investigating antifibrotic agents for people with idiopathic pulmonary fibrosis (IPF) have been conducted in predominantly White and male populations; it is unclear whether other SDH have been considered. This study aimed to investigate active consideration and reporting of SDH in clinical trials of antifibrotic agents for people with IPF.</p><p><strong>Methods: </strong>Three registries (ClinicalTrials.gov, ANZCTR and International Standard Randomised Controlled Trial Number (ISRCTN)) plus CENTRAL (Cochrane Central Register of Controlled Trials) were searched for clinical trials investigating antifibrotic agents for people with IPF or various progressive fibrotic ILD variants registered from 1 January 2000 until 3 September 2023. Data were extracted regarding trial phase/status, recruitment strategies and eligibility criteria. If trial results were available, SDH data from demographics and subgroup analyses were extracted.</p><p><strong>Results: </strong>Of 313 records identified, 70 trials were included. The majority of trials were phase II or III (77%), 56% were completed and 61% had reported results that included eight terminated trials. All 70 trials specified age and sex, but not other SDH, within their eligibility criteria. Of 43 trials reporting results, all reported age and sex and 40 (95%) reported ethnicity. 10 387 participants were described (74% male, 77% White, 16% Asian and <1% Black). Descriptors for ethnicity varied considerably. Five trials (12%) included only White participants and three (7%) included only Asian participants. No other SDH were reported.</p><p><strong>Conclusions: </strong>SDH beyond age, sex and ethnicity were neither considered nor reported in antifibrotic IPF trials. Trial populations were predominantly male and White. There is a need to actively consider SDH to ensure diverse and representative clinical trial populations.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cough monitoring systems in adults with chronic respiratory diseases: a systematic review.","authors":"Latisha E Witjaksono, Max Schulte, Anne E Holland, Marlies S Wijsenbeek, Yet H Khor","doi":"10.1183/16000617.0212-2023","DOIUrl":"10.1183/16000617.0212-2023","url":null,"abstract":"<p><strong>Background: </strong>The role of objective cough monitoring systems for assessments in adults with chronic respiratory diseases (CRDs) is unclear. This systematic review aimed to synthesise current literature on frequency of use and characteristics of these systems.</p><p><strong>Methods: </strong>MEDLINE, Embase and CENTRAL were systematically searched to identify relevant literature evaluating cough in adults with CRDs using objective cough monitoring systems. The primary outcomes were utility and characteristics of the systems, with the secondary outcome being usability.</p><p><strong>Results: </strong>We identified 54 primary studies (4909 patients, with 3364 having idiopathic chronic cough). Included studies were generally of low risk of bias. Objective monitoring systems identified were VitaloJAK (n=19 studies), Leicester Cough Monitor (LCM, n=18), LEOSound (n=2), PulmoTrack (n=2), Hull Automated Cough Counter (HACC, n=1), LifeShirt (n=1), and unnamed devices (n=11). There was limited assessment against manual counting, with low-to-moderate correlation to patient-reported outcome measures for VitaloJAK (p<0.05), LCM (r=0.43-0.78) and unnamed devices (r=0.38-0.40). Test-retest consistency was evaluated in two studies, showing favourable results. There was at least moderate effect size of longitudinal measurement changes to various treatments for VitaloJAK (nine out of 16), LCM (two out of eight), HACC (n=1), LCM and HACC (n=1), PulmoTrack (n=1) and unnamed devices (n=3).</p><p><strong>Conclusions: </strong>Few studies evaluated the agreement of objective cough monitoring systems against manual counting. Most studies were conducted in patients with idiopathic chronic cough, with the VitaloJAK and LCM being were the most evaluated objective cough monitoring systems. Further evaluation of objective cough monitoring systems is needed for research and clinic application.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viral reactivations and fungal infections in nonresolving acute respiratory distress syndrome.","authors":"Lenn Maessen, Leonoor S Boers, Jannes Heylen, Frank van Someren Gréve, Joost Wauters, Lieuwe D J Bos, Simon Feys","doi":"10.1183/16000617.0153-2024","DOIUrl":"10.1183/16000617.0153-2024","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a condition affecting 10% of patients requiring admission to the intensive care unit and results from endothelial dysfunction, alveolar epithelial injury and unbalanced inflammation, leading to exudative pulmonary oedema. A significant portion of these patients experience a lung injury that fails to resolve. Persistent or worsening respiratory failure beyond 5 days after the initiation of mechanical ventilation is referred to as nonresolving ARDS. Viral and fungal pathogens can exploit the hyperinflammatory environment and altered immune landscape in ARDS, perpetuating a cycle of ongoing inflammation and lung injury, thereby contributing to the progression towards and persistence of nonresolving ARDS, even in previously immunocompetent patients. This review discusses the significance, pathophysiology, diagnostic challenges and key knowledge gaps concerning various viral and fungal pathogens in nonresolving ARDS, with a particular focus on influenza-associated and COVID-19-associated pulmonary aspergillosis and pulmonary reactivation of <i>Herpesviridae</i>, such as cytomegalovirus and herpes simplex virus. Diagnosing these infections is challenging due to their nonspecific clinical presentation and the inability of current tests to distinguish between fungal colonisation or asymptomatic viral shedding and clinically significant infections or reactivations. A deeper understanding of the complex interplay between these pathogens and the host immune system in the context of ARDS, combined with advances in diagnostic and therapeutic strategies, has the potential to enhance the management and prognosis of patients with nonresolving ARDS.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"34 175","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}