European Respiratory Review最新文献

{"title":"COPD maintenance trials use heterogeneous outcomes and measurement instruments: a systematic literature review.","authors":"Vi Truong, Sulaiman Bin Safar, Sachin Ananth, Markus Fally, Augusta Beech, Sara Souto-Miranda, Nawar Diar Bakerly, Sarah L Gorst, Dave Singh, Jørgen Vestbo, Lies Lahousse, Alexander G Mathioudakis","doi":"10.1183/16000617.0300-2025","DOIUrl":"10.1183/16000617.0300-2025","url":null,"abstract":"<p><strong>Background: </strong>Randomised controlled trials (RCTs) of COPD management assess heterogeneous outcomes with diverse instruments and often omit those important to patients and healthcare professionals, limiting interpretability and comparability. This review aimed to identify the outcomes and instruments used in phase III/IV COPD maintenance management RCTs and assess their consistency.</p><p><strong>Methods: </strong>We systematically reviewed all phase III/IV RCTs registered on ClinicalTrials.gov between 2010 and 2025 evaluating COPD maintenance management. Outcomes and measurement instruments were extracted from registry entries and categorised using the COMET (Core Outcome Measures in Effectiveness Trials) taxonomy. Registered outcomes from a random 10% sample were compared with the corresponding publications to assess concordance. Outcome frequencies were summarised across intervention types and sponsor categories.</p><p><strong>Results: </strong>43 unique outcomes were identified across 240 eligible RCTs. Physiological (89.5%), clinical (85.0%) and life impact outcomes (63.8%) were most frequently assessed, whereas resource use (39.6%), safety (36.7%) and mortality (16.7%) outcomes were less commonly reported. Only lung function (76.3%) and health-related quality of life (57.5%) appeared in over half of the trials. Exacerbations were reported in 40.4% of studies, while several patient-prioritised outcomes, particularly activities of daily living (5.4%) and exercise tolerance (18.3%), were infrequently assessed. Industry-sponsored RCTs more often reported lung function, resource use and adverse events; non-industry trials more frequently included biomarkers. Concordance between registered and published outcomes was acceptable (79.7%), although safety outcomes and instruments were sometimes under-reported.</p><p><strong>Conclusion: </strong>COPD maintenance management RCTs show substantial heterogeneity and incomplete assessment of patient-prioritised outcomes. An internationally representative, multi-stakeholder core outcome set is urgently needed to improve consistency and patient-centred evaluation in future trials.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411107","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":"Air pollution-induced airway epithelial barrier dysfunction in COPD: a narrative review of mechanisms and therapeutic implications.","authors":"Zhong He, Puxu Yang, Lina Shao, Xinhui Fang, Zhenkun Zhao, Wei Sun, Yuxiu Song, Ying Xu, Xiaoyu Zhao, Ziwen Ma, Yuanyi Yue, Xueqing Wang, Qiang Zhang","doi":"10.1183/16000617.0171-2025","DOIUrl":"10.1183/16000617.0171-2025","url":null,"abstract":"<p><p>Air pollution is particularly harmful to people with chronic obstructive pulmonary disease (COPD). Exposure to air pollution from sources such as biomass burning leads to a unique COPD phenotype. This phenotype mainly shows airway damage, with less emphysema than typical smoking-related phenotypes. Across various COPD phenotypes, airway epithelial barrier dysfunction is a basic pathological mechanism. This narrative review summarises the current available evidence on how different types of airborne pollutants, including particulate matter (PM), ozone (O₃), diesel exhaust and microplastics, damage the airway epithelial barrier. The toxicity of fine PM with a diameter of ≤2.5 µm, one of its main constituents, largely depends on its chemical composition. Some metals or organic chemicals with redox properties can initiate oxidation reactions and induce pathologic responses. The main injury mechanisms are direct physical damage to apical junctional complexes, serious impairment of mucociliary clearance and induction of oxidative stress. Apart from these immediate harms, pollutants also create epigenetic modifications and disturbed epithelium-immune cell cross-talk, which breaks down the equilibrium of the airway epithelial barrier. These system-wide effects are exacerbated through the gut-lung axis, which aggravates local lung damage <i>via</i> microbiome dysregulation. We evaluate emerging therapeutic strategies that aim to restore barrier integrity, including antioxidants, natural compounds, inhibitors directing specific pathways (<i>e.g.</i> epidermal growth factor receptor (EGFR), NLR family pyrin domain containing 3 (NLRP3)) and microbiome modulation <i>via</i> probiotics. Protection and repair of the airway epithelial barrier offer a promising approach to reducing the onset and progression of pollution-related COPD in populations vulnerable to highly polluted environments.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367665","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":"Implementing acute exacerbations of COPD care bundles: evidence, effectiveness and future directions.","authors":"Jian Wang, Chenxi Shi, Yingxiang Lin","doi":"10.1183/16000617.0032-2026","DOIUrl":"10.1183/16000617.0032-2026","url":null,"abstract":"<p><p>Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent a major driver of disease progression, healthcare utilisation and mortality worldwide. Despite robust guideline recommendations, substantial variability persists in the real-world management of AECOPD, particularly during hospitalisation and the vulnerable post-discharge period. Care bundles, defined as a small set of evidence-based interventions delivered collectively and reliably, have emerged as a pragmatic strategy to bridge the evidence-practice gap. This narrative review synthesises contemporary evidence on the structure, implementation strategies and clinical impact of AECOPD care bundles across the continuum of care. We summarise core bundle components during the acute in-hospital phase and the transition-to-discharge phase, critically appraise their effects on readmission, length of stay and mortality, and explore the heterogeneity between efficacy under controlled conditions and effectiveness in real-world settings. Drawing on principles from implementation science, we analyse multilevel barriers at system, provider and patient levels, and highlight facilitators including multidisciplinary team models, digital health-enabled decision support and iterative quality-improvement cycles. We propose that AECOPD care bundles function not merely as collections of interventions, but as delivery frameworks that improve the reliability of evidence-based care across the admission-to-discharge pathway. Current evidence suggests potential benefit for selected short-term outcomes, particularly readmission-related measures, but overall effectiveness remains heterogeneous and highly dependent on implementation fidelity, service organisation and post-discharge support. Future progress will depend on clearer bundle specification, context-sensitive design, integration of digital tools and greater emphasis on patient-centred outcomes.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367739","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":"Respiratory support in paediatric patients with bronchiolitis: a systematic review and meta-analysis.","authors":"Spyridon Karageorgos, Anastasios Panagiotis Chantzaras, Aris P Agouridis, Aidan Beegan, Nicola O'Shea, Tessa Davis, Michael Barrett","doi":"10.1183/16000617.0223-2025","DOIUrl":"10.1183/16000617.0223-2025","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that high-flow nasal cannula (HFNC) may confer better clinical outcomes compared with other respiratory support modalities in paediatric patients with bronchiolitis.</p><p><strong>Methods: </strong>We performed a literature search up to 21 January 2024 on PubMed, Scopus, Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform and Clinicaltrials.gov. Randomised controlled studies including paediatric patients aged ≤24 months with bronchiolitis comparing the use of HFNC <i>versus</i> low-flow nasal cannula (LFNC) or continuous positive airway pressure (CPAP) were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random-effect modelling was used to estimate pooled effects.</p><p><strong>Results: </strong>18 studies with 4094 patients were included. HFNC did not reduce the need for mechanical ventilation compared to LFNC (risk ratio 0.69, 95% CI 0.33-1.44; p=0.32) or CPAP (risk ratio 0.90, 95% CI 0.65-1.24; p=0.52). HFNC resulted in less treatment failure compared to LFNC (risk ratio 0.44, 95% CI 0.23-0.87; p=0.02), whereas there was no difference compared to CPAP (risk ratio 1.28, 95% CI 0.90-1.80; p=0.17). HFNC was associated with significant reduction in length of paediatric intensive care unit (PICU) stay compared to LFNC (mean difference (MD) -0.40 95% CI -0.78- -0.02; p=0.04), but not compared to CPAP (MD -0.24, 95% CI -0.91-0.43; p=0.47).</p><p><strong>Interpretation: </strong>HFNC significantly reduced treatment failure, length of PICU stay and total oxygen therapy duration compared to LFNC. No differences between HFNC and CPAP in primary and secondary outcomes. HFNC could be considered as initial treatment modality in paediatric patients with bronchiolitis, especially in patients requiring escalation of treatment from LFNC.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367721","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":"Preclinical human models of primary ciliary dyskinesia.","authors":"Jonathan W Y Ong, Claire L Jackson, Marina Arbi, Stephen L Hart, Pleasantine Mill, Tamara Paff, Bruna Rubbo, Eriomina Shahaj, Amelia Shoemark, Jane S Lucas","doi":"10.1183/16000617.0334-2025","DOIUrl":"10.1183/16000617.0334-2025","url":null,"abstract":"<p><p>Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disorder caused by defective motile cilia, resulting in impaired mucociliary clearance, chronic respiratory disease, laterality defects and subfertility. Currently, no disease-modifying treatments exist. Targeting PCD at its root cause requires emerging genetic therapies, such as small molecules, oligonucleotides, mRNA therapy, gene replacement and genome editing. With over 52 implicated genes and numerous patient-specific variants, there is a need for robust preclinical models to evaluate and accelerate these approaches. This review examines human preclinical models that recapitulate patient-specific genotypes and phenotypes while providing sufficient scalability for screening and detailed efficacy assessment. The models should also resolve knowledge gaps, including which cells need targeting and at what stage of differentiation. Air-liquid interface cultures of primary human airway epithelial cells or induced pluripotent stem cells (iPSCs) represent the current practice, alongside three-dimensional organoids, spheroids and lung-on-a-chip platforms. To overcome the limited proliferative capacity of primary cells, strategies include <i>BMI-1</i> or <i>hTERT</i> transduction, conditional reprogramming with Rho-associated kinase (ROCK) inhibitors and feeder layers, and differentiation of iPSCs. Patient-derived and CRISPR-edited models have been developed for multiple PCD genes. Outcome measures to confirm efficacy of the therapy include high-speed video microscopy for quantifying ciliary beat pattern, transmission electron microscopy for ultrastructural assessment, mucociliary clearance assays and deep molecular phenotyping. There is a need for field-wide standardisation through consensus protocols, core outcome sets, minimum reporting criteria, quality benchmarks and regulatory alignment to facilitate accelerated translation of preclinical findings to clinical therapeutics.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367713","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":"Utilising human cellular models of primary ciliary dyskinesia: a scoping review.","authors":"Jonathan W Y Ong, William Tsang, Jane S Lucas, Claire L Jackson, Bruna Rubbo","doi":"10.1183/16000617.0193-2025","DOIUrl":"10.1183/16000617.0193-2025","url":null,"abstract":"<p><strong>Background: </strong>Primary ciliary dyskinesia (PCD) comprises a group of rare genetic disorders that primarily affect the function of motile respiratory cilia, leading to progressive sinopulmonary disease. Disease models can be used to investigate potential therapies or responses to environmental exposures. We sought to identify and describe knowledge gaps in the modelling approaches and outcome measures used in applied <i>in vitro</i> or <i>ex vivo</i> human respiratory cellular models of PCD.</p><p><strong>Methods: </strong>We conducted a scoping review of Medline and Embase (2000-2024), screening studies of <i>in vitro</i> or <i>ex vivo</i> human respiratory cellular models of PCD and charted modelling approaches, applications and outcome measures.</p><p><strong>Results: </strong>Of the 612 screened abstracts, 10 articles were included in the qualitative synthesis. The modelling approaches included primary cell culture at an air-liquid interface (ALI) (n=5), spheroid culture (n=2), organoid culture (n=2) and induced pluripotent stem cell-derived ALI culture (n=1). Modelling protocols were heterogenous. Applications included 1) therapeutic gene correction or replacement applications (n=4) and therapeutic drug screening (n=1), or 2) exposure to infection (n=4), drugs (n=3) and house dust mite allergen (n=1). Outcome measures used for both model characterisation and evaluation of therapeutic interventions were inconsistent. Certain outcome measures, such as ciliary function, were reported inconsistently, which limited interpretability of findings.</p><p><strong>Conclusion: </strong>A variety of PCD models exist but a lack of standardised characterisation hinders the reproducibility and comparability of findings. Consensus is needed on the minimum requirements for model characterisation and standardised reporting of outcome measures, which will facilitate model development for therapeutic and exposure applications.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367708","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":"Bench evidence, bedside uncertainty: hyperoxia, mechanical ventilation and lung injury.","authors":"Emily E Nadeau, Andreas Schwingshackl, Jamie L Sturgill, Christopher M Waters","doi":"10.1183/16000617.0058-2026","DOIUrl":"10.1183/16000617.0058-2026","url":null,"abstract":"<p><p>The management of respiratory failure often necessitates the use of supplemental oxygen and mechanical ventilation, both crucial interventions in critical care. However, this combination of hyperoxia (defined as exposure to supra-atmospheric levels of oxygen) and mechanical ventilation can lead to significant additional lung injury. The aim of this review is to synthesise current evidence defining how hyperoxia primes the adult lung for increased susceptibility to the development of lung injury during mechanical ventilation and to contextualise these mechanisms within contemporary clinical research and practice. We review experimental and translational studies elucidating the interplay between oxidative stress, cytoskeletal remodelling, inflammation, and alveolar-capillary barrier dysfunction, highlighting how these processes initiate or amplify pre-existing lung injury. We also examine current approaches to oxygen therapy, both as a standalone intervention and in the context of ventilator management. While the injurious role of hyperoxia in animal models is highly consistent and reproducible, clinical trials have been less consistent in directly linking hyperoxia exposure to increased patient mortality. Although clinical trials comparing liberal <i>versus</i> conservative oxygen strategies have yielded conflicting results over decades, emerging mechanistic insights from pre-clinical models may help identify patient subpopulations at greatest risk for hyperoxia-associated lung injury. By integrating evidence from basic science and clinical studies, this review underscores the importance of judicious oxygen titration to mitigate iatrogenic lung injury and optimise outcomes in critically ill patients.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367729","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":"East Asia as a sentinel: risk-stratified corticosteroid therapy for paediatric macrolide-resistant <i>Mycoplasma pneumoniae</i> pneumonia.","authors":"Yi-Siang Huang, Kuang-Che Kuo, Yu-Tsun Su, Hong-Ren Yu","doi":"10.1183/16000617.0047-2026","DOIUrl":"10.1183/16000617.0047-2026","url":null,"abstract":"<p><strong>Background: </strong><i>Mycoplasma pneumoniae</i> is a major cause of paediatric community-acquired pneumonia. The prevalence of macrolide-resistant <i>M. pneumoniae</i> (MRMP) has exceeded 80% in East Asia, posing significant challenges to clinical management. Increasing evidence suggests that disease progression is driven not only by direct microbial injury but also by host-mediated hyperinflammatory responses.</p><p><strong>Methods: </strong>This structured narrative review was conducted using PubMed and Embase databases to identify relevant studies published between 2000 and 2025. Clinical studies, biomarker analyses and regional guidelines, particularly from East Asia, were reviewed to examine the indications, timing and risk-stratified use of systemic corticosteroids in refractory and severe <i>M. pneumoniae</i> pneumonia.</p><p><strong>Results: </strong>Available evidence suggests that management of MRMP often involves both second-line antimicrobial therapy and consideration of adjunctive immunomodulation. Among available biomarkers, lactate dehydrogenase (LDH) has been most frequently reported in association with refractory disease. Elevated LDH levels (commonly around 400 IU·L^-1), particularly when dynamically rising, have been associated with increased risk of disease progression, although thresholds vary across studies. Reported treatment strategies include conventional-dose methylprednisolone (1-2 mg·kg^-1·day^-1) in refractory cases and higher-dose regimens (10-30 mg·kg^-1·day^-1) in severe hyperinflammatory presentations, with careful clinical assessment.</p><p><strong>Conclusion: </strong>Corticosteroids may represent a potential adjunctive strategy rather than a last-resort intervention in selected patients. A risk-stratified approach integrating clinical severity, radiologic progression and biomarker profiles may help guide individualised treatment decisions, although the overall evidence remains heterogeneous and further studies are needed.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 181","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367667","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":"Systemic corticosteroids for severe community-acquired pneumonia: a narrative review of mechanisms and critical appraisal of recent trials in ICU.","authors":"Benjamin Eastwood, Isis Terrington, Rebecca Young, Olivia Cox, Elizabeth Webb, Cathrine McKenzie, Kordo Saeed, Andrew Conway-Morris, Michael P W Grocott, Ahilanandan Dushianthan","doi":"10.1183/16000617.0259-2025","DOIUrl":"10.1183/16000617.0259-2025","url":null,"abstract":"<p><p>Clinical trials investigating the effect of systemic corticosteroids as an adjunctive therapy for severe community-acquired pneumonia (sCAP) requiring admission to the intensive care unit have produced heterogeneous results over recent decades. The most recent trials, despite being significantly larger than their predecessors, have displayed similarly heterogeneous results. This narrative review aims to explore the possible underlying reasons for this heterogeneity of treatment effect, providing detail for each of the proposed immune- and nonimmune-mediated mechanisms through which corticosteroids might offer therapeutic benefit for patients with severe pneumonia and providing an in-depth critical appraisal of the most recent large-scale multicentre randomised controlled trials, namely ESCAPe (2022), CAPE COD (2023) and REMAP-CAP (2025). We discuss the importance of recognising sCAP as a heterogeneous disease, in which local processes in the lung are not always reflected in systemic features, and the need for further characterisation of endotypes of the disease.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316367","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 biomarkers for diagnosis and monitoring of respiratory disease: a systematic review.","authors":"Jinming Xu, Thayabaran Kathiresan, Alveena Siddiqui, Stuart B Mazzone, Adam Vogel","doi":"10.1183/16000617.0288-2025","DOIUrl":"10.1183/16000617.0288-2025","url":null,"abstract":"<p><p>Cough is a common and physiologically informative component of respiratory morbidity, but its potential for diagnosing and monitoring disease is not thoroughly investigated. This systematic review synthesised the literature on algorithmic and statistical models analysing cough acoustics for diagnosing or monitoring respiratory conditions. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, five databases (PubMed, Embase, Scopus, Web of Science and CENTRAL) were systematically searched for studies published from January 2010 to June 2025. Eligible studies performed quantitative acoustic feature analysis of human coughs using statistical, machine learning or deep learning models and reported diagnostic or prognostic performance. 89 studies from 34 countries were assessed, covering cough detection (n=31), disease classification (n=55) and disease severity prediction (n=3), reflecting potential applications in disease monitoring. Deep learning approaches, especially convolutional and recurrent networks, were predominant (n=56) and tended to achieve the higher accuracies, although machine learning ensemble methods and logistic regression also demonstrated strong performance, particularly with well-engineered features. Across different diseases, sensitivities and specificities were often reported to be ≥90%, notably for tuberculosis, asthma and COVID-19. However, methodological weaknesses were common, with only 11.2% of studies introducing external validation, 71.1-87.6% demonstrating high risk of bias (according to PROBAST-AI) and most based on small, homogeneous or crowdsourced cohorts with limited generalisability. These limitations contribute to inflated internal performance and uncertainty about real-world applicability. Cough acoustic biomarkers hold promise as an adjunctive tool for screening and longitudinal monitoring in low-resource environments. Nevertheless, widespread implementation will require large, multicentre validation, standardised calibration, bias control and incorporation into privacy-preserving workflows.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316439","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}