Paediatric Respiratory Reviews最新文献

{"title":"Image-guided pediatric airway endoscopy: A review.","authors":"Haley Haskett, Michal Trope, Antoinette Wannes Daou","doi":"10.1016/j.prrv.2026.06.006","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.006","url":null,"abstract":"<p><p>Pediatric airway endoscopy, including nasopharyngolaryngoscopy (NPL), microlaryngobronchoscopy (MLB), and flexible bronchoscopy, plays an essential role diagnosing and managing airway disorders in children. Each technique offers unique distinct advantages, and when paired with imaging modalities such as X-rays, fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI), clinicians gain a more comprehensive and accurate assessment of the airway. This review explores the complementary role of endoscopy and imaging in pediatric airway evaluation, emphasizing how their combined use improves diagnostic accuracy, guides treatment planning, and facilitates multidisciplinary care. While endoscopy remains the gold standard for visualizing airway pathology, integrating imaging enhances understanding of both structural and functional abnormalities, ultimately improving clinical outcomes in this vulnerable patient population.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopic and interventional management of tracheobronchomalacia in children with bronchopulmonary dysplasia: a review of evidence.","authors":"Dirk Schramm, Putri Amelia, Nadine Freitag, Wahyuni Indawati","doi":"10.1016/j.prrv.2026.06.005","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.005","url":null,"abstract":"<p><p>Tracheobronchomalacia (TBM) remains a challenging condition in pediatric respiratory medicine. It arises from diverse etiologies involving intrinsic tracheal collapse and extrinsic airway compression. Although diagnostic criteria have progressed over time, flexible bronchoscopy remains the gold standard, as it enables direct assessment of dynamic airway changes, with a >50% reduction in airway lumen during forced expiration considered indicative of TBM. TBM represents one of the principal consequences of bronchopulmonary dysplasia (BPD) and plays a decisive role in the clinical course of affected children. The pathophysiological connection between BPD and TBM stems from multiple factors: prolonged mechanical ventilation, chronic inflammation, and altered development of airway cartilage in premature infants. Pharmacological treatment plays a key role in managing large airway disease (LAD) in infants with severe BPD by optimizing airway stability and reducing respiratory distress. Chest physiotherapy can enhance mucociliary clearance and support respiratory mechanics in patients with TBM, while in more severe cases surgical or bronchoscopic interventions, such as airway stenting, are often required. TBM in the context of BPD adds substantial clinical complexity, necessitating a comprehensive understanding of disease mechanisms and individualized therapeutic strategies. Evidence supporting available interventions is heterogeneous; non-invasive ventilation strategies hold the strongest support from randomized controlled trials, whereas bronchoscopic and surgical procedures rely largely on observational studies, case series, and expert opinion. This variability underscores the need for further research, particularly controlled trials comparing different management strategies where ethically and practically feasible.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving the goalposts from symptom control to preventing airway remodeling in preschool asthma.","authors":"Larry C Lands","doi":"10.1016/j.prrv.2026.06.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.002","url":null,"abstract":"<p><p>Recurrent wheezing in preschool aged children is a common reason for consultation to the pediatric respirologist. However, the definition of preschool asthma, the various phenotypes and associated investigations required to define these phenotypes, the goals of therapy, and considerations for therapeutics, including biologics, are all areas needing further development. Let's begin with an illustrative case.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand in glove: New imaging techniques and airway endoscopy.","authors":"Dominic A Fitzgerald, Jason C Woods","doi":"10.1016/j.prrv.2026.06.004","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.004","url":null,"abstract":"","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148331875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotyping bronchopulmonary dysplasia using magnetic resonance imaging.","authors":"Samal Munidasa, Paul S Kingma, Jason C Woods, James A Rowe","doi":"10.1016/j.prrv.2026.06.003","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.003","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia (BPD) is characterized by impaired lung development and persistent respiratory morbidity. BPD comprises three primary phenotypes: parenchymal, airway, and pulmonary vascular disease. Parenchymal disease involves disrupted alveolar growth, emphysema, hyperinflation, inflammation, and fibrosis, leading to impaired gas exchange. Airway disease, including airway malacia and subglottic stenosis, causes airflow obstruction and increased work of breathing. Pulmonary vascular disease involves abnormal vascular remodeling and increased pulmonary vascular resistance, which contributes to the development of pulmonary hypertension. Imaging plays a central role in evaluating these phenotypes which may occur independently or overlap with other phenotypes. Advanced MRI techniques enable non-invasive assessment of lung structure, ventilation, perfusion, airway shape and dynamics, vascular remodeling, and ventricular morphology and function. Imaging-based phenotyping can enhance disease monitoring, risk stratification, and help to inform personalized management strategies in infants with BPD.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to monitor response to biologics in children with severe asthma.","authors":"Latika Gupta, Michele Arigliani, Atul Gupta","doi":"10.1016/j.prrv.2026.05.009","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.05.009","url":null,"abstract":"<p><p>Severe paediatric asthma imposes a substantial health and financial burden. Biologics-monoclonal antibodies targeting specific asthma inflammatory pathways, are transforming severe asthma management. Currently approved biologics for paediatric use (≥6 or ≥12 years of age) include anti-immunoglobulin E (omalizumab), anti-interleukin (IL)-5 (mepolizumab), ultra-long acting anti-IL5 (depemokimab), anti-IL-5 receptor (benralizumab), anti-IL4/IL-13 (dupilumab), and anti-thymic stromal lymphopoietin (TSLP) (tezepelumab). While clinical trials have shown promising results, real-world data on long-term efficacy and safety in children and adolescents remain limited. Moreover, guidelines for initiating, monitoring biologics and assessing treatment response varies across countries lacking consensus. This is the second in a series of narrative reviews on biologics in severe paediatric asthma. The first review summarised key clinical trials findings and offered practical guidance for initiating therapy. In this review, we focus on strategies for monitoring treatment response, the role of asthma biomarkers and the potential of emerging therapies. We also highlight current research gaps and future directions to optimise biologics use in children and adolescents with severe asthma.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early childhood asthma and adenotonsillectomy: From upper airway microbiota to type 2 biomarkers and clinical outcomes.","authors":"Katarzyna Zyzynska, Magdalena Rodziewicz, Kamila Grycner, Dmitry Tretiakow, Beata Stefania Lipska-Zietkiewicz, Andrzej Skorek","doi":"10.1016/j.prrv.2026.05.008","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.05.008","url":null,"abstract":"<p><p>Early childhood asthma is one of the most common chronic diseases in children, and its course may be modified by coexisting upper airway obstruction. It remains uncertain whether adenoidectomy or adenotonsillectomy can improve asthma control or reduce exacerbations in children with asthma and obstructive symptoms. Emerging evidence links asthma phenotype, type 2 inflammatory biomarkers (fractional exhaled nitric oxide, blood eosinophilia, periostin, chitinase) and changes in upper airway microbiota with variable clinical responses to surgery. This narrative review summarises studies evaluating the impact of adenoidectomy and adenotonsillectomy on asthma outcomes in paediatric populations, including secondary analyses of major randomised controlled trials (CHAT, PATS). Across heterogeneous cohort and database studies, surgery is associated with improved symptom control and reductions in hospitalisations and emergency visits in selected children, particularly younger patients with severe obstruction and poorly controlled disease despite pharmacotherapy. A post-hoc analysis of the CHAT trial demonstrated a significant reduction in wheezing after adenotonsillectomy, and a secondary analysis of the PATS trial showed a trend toward improved asthma symptom burden, although neither trial was designed with asthma as a primary endpoint. Conversely, some large population-based analyses suggest a neutral effect or even an increased long-term risk of asthma in specific subgroups, underscoring substantial uncertainty. Critically, no randomised controlled trial has evaluated asthma control or exacerbation rate as a primary outcome after adenotonsillectomy, and overall evidence quality is low to very low. Adenotonsillectomy should therefore be considered a targeted option for a carefully selected subgroup of young children with documented upper airway obstruction and poorly controlled asthma, rather than a routine intervention. Well-designed multicentre prospective studies with standardised asthma endpoints, detailed phenotyping and microbiome and biomarker assessment are needed to clarify which patients derive durable benefit and to define the role of surgery within personalised asthma management.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long term lung health in children: new emerging threats and preventive strategies.","authors":"Eugenio Baraldi, Luca Bonadies, Stefania La Grutta, Peter Le Souëf, Terry L Noah, Iso Oloyede, Heather J Zar, Andrew Bush","doi":"10.1016/j.prrv.2026.06.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.001","url":null,"abstract":"<p><p>The long-term consequences of early adverse exposures are well known but is becoming clear that early means not just in pregnancy but also in at least the two preceding generations. Furthermore, there are new existential threats to long term respiratory health, some of which have been presented at the INSPiRED meeting in Bologna and are reviewed in this manuscript. One such is premature delivery, with ever smaller babies surviving with new respiratory and systemic complications, but there is also an appreciation that even those who do not develop bronchopulmonary dysplasia may have long term complications. New environmental hazards include vapes and other devices designed to produce a new generation of nicotine addicts; gas flaring which ruthlessly maximises profit at the expense of the environment and those living close by; and climate change, perhaps the greatest threat of all. Compounding these challenges is the effects of displacement by war or natural disasters on increasing numbers of children. On the other hand, encouragingly, two new highly effective strategies for the prevention of respiratory syncytial virus infection are becoming widely available, namely maternal immunisation with a pre-fusion vaccine in the third trimester of pregnancy and a long-acting monoclonal antibody. We await data as to whether these strategies will prevent impairment of lung function and later asthma. However, strong political action is essential if the expanding range of threats to the health of children and young people are to be averted. Awareness of new threats and advocacy are important roles for all paediatricians.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viral respiratory infections in children and metabolomics: a review of literature.","authors":"Parthena Savvidou, Elias Iosifidis, Emmanuel Roilides, Helen Gika, Charalampos Antachopoulos","doi":"10.1016/j.prrv.2026.05.007","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.05.007","url":null,"abstract":"<p><p>Acute respiratory infections (ARIs) are the most common infectious diseases during childhood, responsible for significant morbidity and mortality in the pediatric population worldwide. Metabolomics, the global analysis of small metabolites, is a novel tool that offers insights into diagnostics and prognostics of viral respiratory infections. This review summarizes the existing literature on metabolomic studies in viral acute respiratory infections (ARIs) within the pediatric population. Metabolomic research on patients with bronchiolitis has addressed several clinical questions, such as discrimination by causative agent, i.e. respiratory syncytial virus or rhinovirus, and most importantly prognosis, predicting disease severity and long-term outcomes. In pneumonia, studies have focused on discriminating viral from bacterial etiology and from healthy controls but also predicting disease severity. There is a growing number of studies on metabolomics in ARIs providing a strong foundation for addressing remaining challenges and allowing for more comparable results and greater impact on clinical practice.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchopulmonary dysplasia associated pulmonary hypertension: implications across the lifespan.","authors":"Taylor P Saley, Natalie Villafranco, Megan Griffiths, Kara N Goss","doi":"10.1016/j.prrv.2026.05.006","DOIUrl":"10.1016/j.prrv.2026.05.006","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia is a frequent complication of preterm birth and is often associated with the development of pulmonary hypertension (BPD-PH). BPD-PH is a multifactorial disease with variable hemodynamic phenotypes typically characterized by underdeveloped pulmonary vascular networks with altered microvascular function, carrying significant morbidity and mortality in infancy. Advances in neonatal care have improved the survival of preterm infants. Amongst survivors, there is a trend toward resolution of BPD-PH with adequate respiratory support and somatic growth, highlighting the importance of early recognition and intervention to optimize vascular growth potential. However, as this population ages the idea of \"resolution\" has been brought into question. There is increasing awareness of subclinical or recurrent pulmonary hypertension as survivors of prematurity from childhood through early adulthood suggesting that the vasculature remains at risk throughout life. The natural history of pulmonary vasculature is one of development, growth and aging. Each window presents unique opportunities and potential insults that impact overall BPD-PHseverity and progression. Here we review care of the BPD-PH patient across the lifespan highlighting windows of opportunity to reduce lifetime exposure to pulmonary hypertension.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}