European Respiratory Review最新文献

{"title":"The Sleep and Breathing Conference: a long-standing and unique ERS/ESRS educational activity.","authors":"Maria R Bonsignore, Dirk Pevernagie","doi":"10.1183/16000617.0057-2026","DOIUrl":"10.1183/16000617.0057-2026","url":null,"abstract":"","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927919","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":"Sleep-disordered breathing in children with neurodisabilities.","authors":"Kristien Vanhaverbeke, Merve Selçuk, Refika Ersu, Hui-Leng Tan","doi":"10.1183/16000617.0281-2025","DOIUrl":"10.1183/16000617.0281-2025","url":null,"abstract":"<p><p>The prominence of sleep-disordered breathing (SDB) in children with neurodisabilities is increasingly becoming apparent. Patients can manifest not only obstructive sleep apnoea but also central sleep apnoea, nocturnal hypoxaemia and hypoventilation or often a combination thereof. The impact of SDB on quality-of-life measures has been increasingly demonstrated. This in turn is powering a paradigm shift, where investigation of SDB and subsequent treatment with surgical procedures or respiratory interventions, such as noninvasive ventilation, are increasingly considered in this cohort of patients, whereas historically they may not have been, given perceived barriers to successful treatment. In this review, we aim to summarise the literature on SDB in children with neurodisabilities published in the past two decades. We have concentrated on three main groups of children with neurodisabilities, namely those with cerebral palsy, those with inborn errors of metabolism where disease-modifying therapies are available for selected conditions and those with other genetic conditions resulting in significant neurodisability, such as Rett syndrome.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927884","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":"Should weight loss be the first-line treatment for obstructive sleep apnoea? A pro-con debate.","authors":"Sanjay R Patel, Silke Ryan","doi":"10.1183/16000617.0255-2025","DOIUrl":"10.1183/16000617.0255-2025","url":null,"abstract":"<p><p>Obstructive sleep apnoea (OSA) is a common disorder associated with substantial morbidity. Although obesity is an important pathogenetic factor in OSA, the incorporation of weight loss into routine OSA care is currently limited. The development of glucagon-like peptide-1 (GLP-1) agonists has revolutionised obesity management and raises questions about the role of weight loss in OSA care. A debate was held at the 8th Sleep and Breathing Conference in April 2025 on whether weight loss should be first-line treatment for patients with OSA. Arguments in favour include the large and growing proportion of OSA attributable to excess weight, the effectiveness of modern weight-loss therapies in producing significant weight loss and the extent to which weight loss produces effects on clinical outcomes beyond OSA, such as the positive impact on cardiovascular and metabolic disease incidence and control. Conversely, arguments against include the fact that not all patients with OSA have obesity, the limited impact of weight loss on OSA resolution and the considerable data gap with obesity strategies in OSA including the lack of direct comparisons with CPAP on patient-centred outcomes and the impact on long-term health benefits in OSA patients specifically. Clearly, while more research is needed and treatment decisions should be personalised, clinicians need to gain competency with the use of novel weight-loss treatments as an essential part of OSA care.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927946","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":"Diagnostic and management dilemmas in pulmonary hypertension.","authors":"Robin Condliffe, Jurjan Aman, Athénaïs Boucly, Ellis Cerrone, Etienne-Marie Jutant, Gabor Kovacs, Lilian J Meijboom, Karen M Olsson, Da-Hee Park, Andrei Seferian, Olivier Sitbon, Jean-Luc Vachiery, Anton Vonk Noordegraaf, David Montani, Esther J Nossent","doi":"10.1183/16000617.0337-2025","DOIUrl":"10.1183/16000617.0337-2025","url":null,"abstract":"<p><strong>Introduction: </strong>Although current international guidelines provide comprehensive evidence-based guidance for the management of pulmonary hypertension, clinicians are still regularly faced with uncertainty regarding correct diagnosis and optimal treatment.</p><p><strong>Methods: </strong>Ten diagnostic and management dilemmas were formulated by a panel of experts in the field of pulmonary hypertension. Current evidence was reviewed and a practical approach suggested for each dilemma.</p><p><strong>Results: </strong>Diagnostic and management dilemmas discussed include pulmonary hypertension with high cardiac output, idiopathic pulmonary arterial hypertension in the presence of cardiopulmonary comorbidities, pulmonary hypertension associated with left heart disease, pulmonary hypertension and obesity, chronic thromboembolic pulmonary hypertension mimics and Group 5 pulmonary hypertension associated with sarcoidosis, fibrosing mediastinitis and neurofibromatosis type 1.</p><p><strong>Conclusions: </strong>The suggested approaches are informed by a review of existing evidence and guidelines, as well as clinical experience.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927963","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":"Exploring the role of cold air in airway hyperresponsiveness and asthma diagnostic testing: a systematic review and meta-analysis.","authors":"Nora Fopke Marain, Rani Claus, Marieke Colemont, Steven Ronsmans, Lisa Janssen, Jeroen Vanoirbeek, Dominique Bullens, Lieven Dupont","doi":"10.1183/16000617.0205-2025","DOIUrl":"10.1183/16000617.0205-2025","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a heterogeneous disease, making uniform diagnosis challenging, resulting in both under- and overdiagnosis. We conducted a systematic review and meta-analysis to summarise the data on diagnostic accuracy of a cold air bronchial challenge test (CACh) in exercise-induced bronchoconstriction and asthma.</p><p><strong>Methods: </strong>Databases (PubMed, Embase, Web of Science core collection, Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature <i>via</i> EBSCO) were systematically screened for articles evaluating the use of CACh as a diagnostic tool in exercise-induced bronchoconstriction and asthma. A random-effects model was used to calculate the effect on the reduction in forced expiratory volume in 1 s (FEV₁) by CACh in healthy controls compared to patients with asthma. Risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-Comparative. This study is registered with PROSPERO (www.crd.york.ac.uk/PROSPERO/ identifier number CRD42021290350).</p><p><strong>Results: </strong>After screening and removal of duplicates, 39 studies were included. Aggregate sensitivity and specificity of a FEV₁ decrease ≥10% after CACh were 0.808 and 0.959, respectively. The weighted mean difference in percentage FEV₁ decrease after CACh for patients with asthma compared to healthy controls was -17.58. High heterogeneity (I²=99) was mainly explained by differences in reference tests to diagnose asthma. Application of the trim-and-fill method to account for publication bias imputed eight studies, resulting in a notable reduction in heterogeneity. The overall effect (a significant decrease in FEV₁ in patients with asthma) remained statistically significant (-8.18, p<0.001).</p><p><strong>Conclusion: </strong>Our study shows the high sensitivity and specificity and possible clinical implications of a CACh in the diagnosis of asthma. Further research is needed to confirm this.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927966","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":"Integrated care for chronic respiratory disease: a narrative review.","authors":"Michael C Steiner, Louise Ryan, Irene Valero-Sanchez, Onyeka Umerah, Thomas J C Ward","doi":"10.1183/16000617.0192-2025","DOIUrl":"10.1183/16000617.0192-2025","url":null,"abstract":"<p><p>Integration of healthcare services for people with chronic respiratory disease (CRD) is proposed as a means to improve the delivery of evidence-based therapies, thereby improving outcomes, experience of care and reducing health inequalities. In this narrative review we define categories of integration interventions, present a structured assessment of the evidence supporting both horizontal and vertical integrated care models and case-finding in CRD, and describe the implications for the implementation and scaling of integrated care programmes in clinical practice. Our findings suggest better coordination of the provision of evidence-based interventions through horizontal integration can improve clinical outcomes in CRDs, including reducing episodes of unscheduled care. Vertical integration provided by different organisational units in healthcare systems can enhance delivery of evidence-based interventions but impact on longer-term outcomes is less clear. The available evidence, whilst providing support for integration, does not conclusively support a specific model of care or organisational structure. Careful attention is required to define components of integrated care interventions. Study duration and choice of outcomes are key to evaluating clinical and cost effectiveness in future trials.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927894","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":"Evolution of body image across treatment eras: a systematic review in young people and adults living with cystic fibrosis.","authors":"Cian Greaney, Natalia Cichy, Grace O'Sullivan, Darren Sills, Roisin Cahalan, Audrey Tierney","doi":"10.1183/16000617.0238-2025","DOIUrl":"10.1183/16000617.0238-2025","url":null,"abstract":"<p><strong>Objectives: </strong>Advancements in treatments for cystic fibrosis (CF) have improved prognosis, but variant-specific therapies have also driven weight gain. Traditional challenges to maintain weight are now less prevalent, with new body image concerns potentially emerging. This review aims to synthesise quantitative and qualitative evidence on body image in adults and young people (aged ≥16 years) with CF.</p><p><strong>Methods: </strong>Systematic search of MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health, the Allied and Complementary Medicine Database and the Cochrane Library (January 2011 to August 2025) using CF-related keywords including body image and physical appearance.</p><p><strong>Results: </strong>Searches retrieved 29 eligible studies (26 quantitative, two qualitative, one mixed methods). The Cystic Fibrosis Questionnaire - Revised (CFQ-R) and Cystic Fibrosis Quality of Life Questionnaire (CFQoL) questionnaires assessed body image quantitatively (0-100). 15 studies reported CFQ-R body image scores (58±19 to 78±23) and five reported CFQoL body image scores (21±26 to 76). Pre-modulator era (≤2012) scores ranged from 64±27 to 70±27; initial rollout phase (2012-2019) scores ranged from 58±19 to 81 (post-ivacaftor); and in the widespread modulator era (2020 to present) were 63±32 to 67 (31). Gender effects were inconsistent. Higher body mass index, weight, and body fat were linked to better body image in some studies; psychological wellbeing and lower anxiety/depression consistently correlated with body image. Ivacaftor and life coaching improved body image, while elexacaftor/tezacaftor/ivacaftor, cognitive behavioural therapy, and self-management programmes showed no effect. Functional health was strongly linked to body image.Qualitative findings highlighted influences of gender, weight change, functional and mental health, social support, early eating experiences, and limited clinician-initiated body image discussions.</p><p><strong>Conclusion: </strong>This is the first systematic review of body image in CF since new drug regimens emerged. Emerging body image disturbance patterns highlight the need for clinical strategies to screen for and address body image issues in CF care.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927960","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":"Nocturnal hypercapnia in obstructive sleep apnoea and obesity hypoventilation: from pathophysiology to measurement and treatment.","authors":"Winfried J Randerath, Francesco Fanfulla, Jean Louis Pépin","doi":"10.1183/16000617.0260-2025","DOIUrl":"10.1183/16000617.0260-2025","url":null,"abstract":"<p><p>Breathing disturbances during sleep are associated with intermittent hypoxaemia, arousal and sympathetic activation, which in turn lead to oxidative stress and cardiovascular and metabolic consequences. However, they are also characterised by fluctuations of carbon dioxide levels, switching between hypercapnia and hypocapnia, which contribute to acute and sustained physiological and cellular effects. Changes in arterial carbon dioxide tension (<i>P</i> _aCO₂ ) influence cerebral blood flow, respiratory control and renal function. The complex pathophysiology requires the integration of clinical entities and therapeutical options based on precise measurement of CO₂ Continuous measurements during the night best reflect nocturnal changes in CO₂ levels. Alveolar, arterial, capillary and transcutaneous CO₂ measurements represent distinct characterisations of CO₂ fluctuations. Alveolar and arterial CO₂ levels are very similar and correlate closely to the end-tidal CO₂ (<i>P</i> _ETCO₂ ) in healthy subjects. However, the validity of <i>P</i> _ET _CO₂ is limited in diseases with inhomogeneous lung ventilation and, due to artefacts, during mechanical ventilation. Transcutaneous CO₂ measurement has proven to adequately represent <i>P</i> _aCO₂ , although time delays in response and absolute figures can differ. Obesity hypoventilation syndrome (OHS) exemplifies a frequent clinical condition with multiple pathophysiological components impacting <i>P</i> _CO₂ levels differently across 24 h. Treatment is often delayed due to limited awareness of mild hypercapnia occurring exclusively during night-time. Positive airway pressure (PAP) therapy remains the cornerstone of management. The choice between continuous positive airway pressure or noninvasive ventilation should be guided by the predominant OHS phenotype and the severity of daytime hypercapnia. Management of OHS should also focus on cardiometabolic comorbidities and include a multimodal approach to the underlying obesity.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927889","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":"Normal polysomnography parameters in healthy children: a systematic review and meta-analysis.","authors":"Annelies Van Eyck, Genevieve de Caen, Julia Bokhaut, Henrietta Blinder, Jason Bouziotis, Sherri Lynne Katz, Athanasios Kaditis, Stijn Verhulst, Refika Ersu","doi":"10.1183/16000617.0224-2025","DOIUrl":"10.1183/16000617.0224-2025","url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of normative values for polysomnographic parameters in childhood. This study presents a comprehensive meta-analysis of paediatric polysomnography parameters scored using recent criteria to establish normative values adjusted for age and sex.</p><p><strong>Methodology: </strong>A systematic search was conducted in Web of Science and Scopus for studies that performed overnight polysomnography in healthy children and reported polysomnographic parameters scored using the American Academy of Sleep Medicine criteria (2007 or 2012). Children with previously diagnosed health conditions were excluded. Estimates for sleep, arousals and cardiorespiratory parameters were pooled using a random-effects meta-analysis and the influence of sex and age was assessed using meta-regression.</p><p><strong>Results: </strong>Of 3612 articles, 66 studies were eligible, resulting in a sample size of 2947 healthy children. Pooled estimates and 95% confidence intervals for 34 polysomnographic parameters were established. Meta-regression revealed age-related decrease in total sleep time (TST), sleep period time, TST in stage N3 and REM, number of sleep cycles, total arousals, total leg movements, periodic leg movement index, central apnoea index, apnoea-hypopnoea index (AHI), mean peripheral oxygen saturation (<i>S</i> _pO₂ ), mean heart rate in sleep and REM, while the number of awakenings, TST in stage N2, number of stage shifts, and <i>S</i> _pO₂ nadir increased with age. Sleep latency was the only parameter influenced by sex (change of -1.27 min per 10% increase in the proportion of males).</p><p><strong>Conclusion: </strong>This meta-analysis provides normative polysomnographic data for the paediatric population that can be used as control values in both clinical and research context.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927916","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":"Rural <i>versus</i> urban living and COPD: a systematic review.","authors":"Samit Patel, Joseph Marchant, Surya P Bhatt, John R Hurst","doi":"10.1183/16000617.0290-2025","DOIUrl":"10.1183/16000617.0290-2025","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Emerging evidence suggests disparities in COPD outcomes between rural and urban populations, but no prior review has synthesised these differences globally. Five databases (Medline, Embase, Emcare, CINAHL and Cochrane Central) were searched in May 2025. Eligible peer-reviewed studies directly compared rural and urban populations in at least one of four measures of COPD burden: prevalence, symptom burden, exacerbations or mortality. Study quality was assessed and narrative synthesis was conducted due to heterogeneity in outcome measures. Of 1339 screened studies, 32 met inclusion criteria, spanning 13 countries. COPD prevalence was higher rurally in 83% (15/18) of studies, with 11/15 demonstrating statistical significance. This pattern was consistent across geographical distributions. Total exacerbation rates were higher rurally in 60% (3/5) of studies, although hospitalisations varied significantly. 50% (6/12) of studies reported higher hospitalisation rates in urban areas and 5/12 studies reporting higher rates in rural areas. 86% (6/7) of studies demonstrated higher mortality rurally and symptom burden was higher amongst rural residents in 67% (4/6) of studies; however, the majority of these were conducted in the USA. This review highlights consistent rural-urban inequalities in COPD prevalence and outcomes, reflecting the impact of healthcare inequities, socioeconomic deprivation and environmental exposures on COPD burden in rural areas. Targeted interventions promoting equitable healthcare access, health education, transition to cleaner fuels and rural access to smoking cessation and pulmonary rehabilitation services are essential to mitigate these disparities and improve outcomes in rural populations.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766725","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}