Seminars in respiratory and critical care medicine最新文献

{"title":"T Regulatory Mechanisms in Airway and Interstitial Lung Disease.","authors":"Christopher F Pastore, Brennan D Stadler, Anne I Sperling, Tania E Velez","doi":"10.1055/a-2703-4491","DOIUrl":"10.1055/a-2703-4491","url":null,"abstract":"<p><p>Chronic lung disease is a sequela of unresolving pathogenesis in the lung. Current estimates report approximately 7.4% of the world's population live with chronic respiratory diseases. The architectural differences in the airways and individual alveoli provide unique microenvironments for mechanisms of disease and thus necessitate specialized modes of regulation. A key immune cell type that has the ability to adapt and provide copius regulatory mechanisms are T regulatory cells (Tregs). In the last two decades, studies have revealed that Tregs respond to their microenvironment and phenotypically change to conduct versatile functions; however, during chronic inflammatory diseases, Tregs are potentially skewed toward pathogenic mechanisms. In this review, we will focus on the differential mechanisms of Treg responses in the lung airways versus interstitium as unique microenvironments by focusing on asthma, acute lung injury/airway respiratory disease syndrome, and interstitial lung disease.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087367","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":"Complications Associated with Glucocorticoids Treatment in Critically Ill Patients.","authors":"Paola Confalonieri, Nicolò Reccardini, Stefano Kette, Francesco Salton","doi":"10.1055/a-2661-5208","DOIUrl":"https://doi.org/10.1055/a-2661-5208","url":null,"abstract":"<p><p>Glucocorticoids (GCs) are essential immunomodulatory agents in the management of critically ill patients with severe systemic inflammation, particularly in conditions such as sepsis, acute respiratory distress syndrome, and severe community-acquired pneumonia. When administered in low-to-intermediate doses for short durations (typically ≤4 weeks, including tapering), GCs have demonstrated substantial benefits in improving patient-centered outcomes, including reduced time on mechanical ventilation, shorter ICU stays, and lower mortality rates. However, the risk-benefit profile of GC therapy in critical illness differs markedly from long-term use in chronic inflammatory diseases and must be carefully evaluated. This study provides an evidence-based synthesis of the most relevant complications associated with the use of GCs in critically ill adults. Hyperglycemia is the most frequent metabolic effect, but it is typically transient and manageable with insulin, and is not associated with worse clinical outcomes. The risk of nosocomial infections has not been shown to increase significantly with appropriate dosing; in fact, immunomodulation by GCs may improve bacterial clearance. Nevertheless, clinicians should remain vigilant for opportunistic infections, particularly invasive fungal infections, in high-risk populations such as those with COVID-19. Musculoskeletal effects, including ICU-acquired weakness, appear to result more from underlying disease and immobilization than from GCs themselves, especially at moderate doses. Neuropsychiatric and gastrointestinal complications are dose-dependent and generally reversible. The transient suppression of the hypothalamic-pituitary-adrenal axis underscores the importance of gradual tapering to prevent inflammatory rebound and adrenal insufficiency. Overall, contemporary data support the safety of GCs when used with precision, directed by patient severity and response to treatment, with careful tapering and monitoring. The incorporation of integrative strategies, such as micronutrient and probiotic supplementation, may enhance GC receptor function and reduce required doses, further improving outcomes. Recognizing and managing potential complications enables clinicians to harness the therapeutic potential of GCs in critical illness fully.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252517","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":"Malignancies Presenting with Alveolar Infiltrates: Diagnostic Pitfalls, Radiologic Clues, and Clinical Patterns.","authors":"Akshay Mathavan, Akash Mathavan, Olga Gomez-Rojas, Ali Ataya","doi":"10.1055/a-2716-1746","DOIUrl":"https://doi.org/10.1055/a-2716-1746","url":null,"abstract":"<p><p>Alveolar infiltrates are a common but nonspecific radiologic finding that can obscure the diagnosis of underlying malignancy. While infections and inflammatory processes are typical considerations, a subset of cancers, both primary and secondary, can present with alveolar opacities that mimic these benign conditions. This review synthesizes the spectrum of neoplastic diseases that manifest with an alveolar radiographic pattern, focusing on both primary pulmonary malignancies (such as lepidic-predominant adenocarcinoma, invasive mucinous adenocarcinoma, and pulmonary lymphoma) and select metastatic solid tumors (notably renal cell carcinoma, gastrointestinal cancers, melanoma, and breast cancer) that exhibit a non-destructive, airspace-filling growth. We also describe secondary and paraneoplastic processes, including immune-mediated pneumonitis, eosinophilic pneumonia, leukemic pulmonary hemorrhage, diffuse alveolar hemorrhage, and secondary alveolar proteinosis, that can similarly produce alveolar opacities in the setting of malignancy. Each entity is discussed with emphasis on its clinical presentation, diagnostic approach, imaging features, and distinguishing characteristics. Radiographic findings and other diagnostics are integrated to highlight the importance of early recognition and appropriate investigation. Distinguishing malignant from infectious or inflammatory causes of alveolar disease remains challenging but critical, as misdiagnosis can lead to inappropriate treatment or delays in therapy. Summary tables are provided to support practical clinical differentiation and management. By improving recognition of neoplastic causes of alveolar infiltrates, clinicians may better tailor diagnostic workups and initiate appropriate treatment strategies.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239343","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":"Lysosomal storage disorders.","authors":"Jacopo Cefalo, Bruno Crestani, Alice Guyard, Magali Pettazzoni, Wladimir Mauhin, Marie-Pierre Debray, Raphaël Borie","doi":"10.1055/a-2715-6812","DOIUrl":"https://doi.org/10.1055/a-2715-6812","url":null,"abstract":"<p><p>Lysosomes are intra-cellular organelles that are responsible for degrading and recycling macromolecules. Lysosomal diseases (LDs) are a group of rare inherited diseases caused by deleterious variants affecting genes that encode the lysosomal enzymes, their transporter or their cofactor. Among LDs that are associated with lung involvement and/or interstitial lung disease (ILD) acid sphingomyelinase deficiency [ASMD formerly called Niemann-Pick A, AB and B diseases]) is the most common. An history of lower respiratory tract infections and exertional dyspnoea are the most frequent respiratory manifestations. In ASMD, ILD is frequent and is usually associated with spleen and/or liver enlargement, low platelet count, and low level of high-density lipoprotein-cholesterol. A restrictive lung functional pattern and a reduction in DLCO value are usually observed. Analysis of bronchoalveolar lavage fluid and lung biopsy showing foamy cells can orientate the diagnosis, based on the demonstration of an enzymatic deficiency in sphingomyelinase in the blood, associated with biallelic pathogenic variants of the SMPD1 gene. An enzyme replacement therapy (ERT), based on intravenous recombinant enzyme infusions (olipudase alfa), is available from 2021 with very encouraging results both in pediatric and adult patients affected with type B or AB. Olipudase alfa administration decreased liver and spleen volume, increased DLCO value and improved radiological lung involvement. Available enzyme replacement therapy supports an early diagnosis to implement therapy before any irreversible organ damage.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225854","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":"Advances in Multimodality Management of Localized NSCLC.","authors":"Sushma Jonna, Jowan Al-Nusair, Giordano F Cittolin Santos, Shadia Jalal","doi":"10.1055/a-2715-6723","DOIUrl":"https://doi.org/10.1055/a-2715-6723","url":null,"abstract":"<p><p>Lung cancer represents the most common cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising the vast majority of cases. Outcomes for stage II-III NSCLC remain suboptimal due to late presentation, biological heterogeneity, and limited efficacy of traditional therapies. Recent advances have reshaped the therapeutic landscape, with immunotherapy and targeted treatments now integrated into the management of resectable NSCLC. Landmark trials such as CheckMate 816 demonstrated improved event-free and overall survival with neoadjuvant chemoimmunotherapy approaches. Similarly, adjuvant targeted therapies such as osimertinib and alectinib have shown benefit in patients with EGFR and ALK alterations, respectively. This review provides an overview of evolving diagnostic strategies, highlights pivotal clinical trials, and explores multidisciplinary treatment approaches across stages I to III NSCLC. We also address key challenges including optimal treatment sequencing, patient selection, and duration of therapy. As clinical trial data continue to mature, personalized multimodal strategies guided by molecular and clinical features remain central to improving long-term outcomes in resectable NSCLC.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225778","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":"Lung Cancer with Cystic Airspace: An Overview.","authors":"Frank C Detterbeck, Sora Ely, Edith M Marom, Ami N Rubinowitz, Leah Traube, Lynn T Tanoue, M Patricia Rivera","doi":"10.1055/a-2649-9134","DOIUrl":"10.1055/a-2649-9134","url":null,"abstract":"<p><p>There is increased recognition that some lung cancers arise from or are associated with air-filled cystic spaces. Recognition of precursors is important because these are often overlooked and because some of these cancers progress rapidly once a solid component develops. A systematic review suggests that such precursors typically appear as irregular air cysts; these should be distinguished from bullae and smooth round cysts with paper-thin walls that are often seen incidentally with increasing age. Such irregular cysts usually enlarge slowly before developing a ground glass or small solid component or becoming multiloculated. Such change warrants careful surveillance; continued progression of a solid component justifies intervention. Early intervention is associated with good outcomes; survival markedly diminishes if resection occurs when a more substantial solid component has developed.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601416","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":"Emerging Concepts in Pathogenesis, Multiomics Applications, and Clinical Research in Lymphangioleiomyomatosis.","authors":"Jane J Yu, Nishant Gupta, Minzhe Guo, Tasnim Olatoke, Yan Xu","doi":"10.1055/a-2698-7273","DOIUrl":"10.1055/a-2698-7273","url":null,"abstract":"<p><p>Lymphangioleiomyomatosis (LAM) is a rare, female-predominant, low-grade neoplasm characterized by infiltration of abnormal smooth muscle-like and epithelioid cells into the lung parenchyma, leading to cystic changes and progressive respiratory failure. In recent years, LAM has been an exemplar of meaningful progress in a rare lung disease, driven by close collaboration between patients, scientists, and clinicians, leading to the development of the U.S. Food and Drug Administration (FDA)-approved therapy, a diagnostic biomarker, a worldwide clinic network, and clinical practice guidelines. Integrating state-of-the-art bioinformatics and experimental approaches is helping accelerate the scientific progress in LAM and promises the development of novel biomarkers and therapies in the coming few years.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178324","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":"Glucocorticoid Treatment for Hospital-Acquired and Ventilator-Associated Pneumonia.","authors":"Cécile Poulain, Marwan Bouras, Antoine Roquilly","doi":"10.1055/a-2694-4781","DOIUrl":"10.1055/a-2694-4781","url":null,"abstract":"<p><p>Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain among the most frequent complications in critically ill patients. Despite the implementation of modern preventive strategies and the widespread use of broad-spectrum antibiotics, both the incidence and treatment failure rates remain high. However, no adjunctive therapy is currently recommended. Glucocorticoids have recently attracted renewed interest as potential immunomodulatory agents in this setting. By reducing excessive inflammation and promoting the resolution of the immune response, they may help limit lung injury and improve clinical outcomes. This hypothesis is supported by findings from related conditions such as community-acquired pneumonia, acute respiratory distress syndrome, and severe COVID-19, where corticosteroids have demonstrated benefits in selected populations. However, evidence specific to HAP and VAP remains limited. A few randomized trials have evaluated corticosteroids for prevention, particularly in trauma patients, where findings suggest a potential benefit and highlight the relevance of this strategy in select populations. More recently, individualized approaches based on inflammatory biomarkers have shown promise in identifying patients who are more likely to benefit from corticosteroid therapy. Two randomized controlled trials, currently ongoing to evaluate their role as adjunctive treatment in established HAP and VAP, will help define the efficacy and tolerance of steroids. Given the heterogeneity of immune responses in critically ill patients, a \"one-size-fits-all\" approach is unlikely to be effective. Identifying inflammatory sub-phenotypes using clinical and biological markers (such as C-reactive protein or interleukin-6) may help guide a more personalized use of immunomodulatory therapies. Alterations in the lung microbiome could also influence host response and treatment efficacy. Altogether, corticosteroids represent a promising but still understudied adjunctive strategy for HAP and VAP. Future research should aim to refine patient selection and optimize treatment strategies within a precision medicine framework.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993249","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":"General Approach to Immunocompromised Patients with Pneumonia: Insights from the Latest Consensus Documents.","authors":"Julio Ramirez","doi":"10.1055/a-2709-6182","DOIUrl":"https://doi.org/10.1055/a-2709-6182","url":null,"abstract":"<p><p>Immunocompromised adults with pneumonia represent a growing and heterogeneous patient population requiring a tailored diagnostic and therapeutic approach. This review synthesizes insights from the latest consensus documents and guidelines to provide a structured framework for clinicians managing pneumonia in immunocompromised hosts. Patients are stratified into four categories of immune dysfunction: severely immunocompromised, immunocompromised, abnormal immune system (not at risk for opportunistic pathogens), and no identifiable immune abnormality. This classification informs both the likelihood of infection with core respiratory pathogens and opportunistic pathogens. A comprehensive microbiological evaluation is critical, incorporating sputum, nasopharyngeal swabs, blood cultures, urinary antigens, and, when indicated, bronchoalveolar lavage and biopsy. For most immunocompromised patients presenting with community-acquired pneumonia, empiric therapy parallels that of non-immunocompromised hosts. Empiric coverage for opportunistic pathogens is warranted in unstable patients with compatible risk factors, when delay therapy may increase mortality.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150822","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":"Pneumonia in post solid organ transplantation.","authors":"Paula O Narvaez-Ramirez, Cristian C Serrano-Mayorga, Ingrid G Bustos, Luis Felipe Reyes","doi":"10.1055/a-2708-4873","DOIUrl":"https://doi.org/10.1055/a-2708-4873","url":null,"abstract":"<p><p>Solid organ transplantation (SOT) has significantly increased over the past few decades, with more than 170,000 SOTs performed worldwide in 2023. Although immunosuppressive treatments have improved patient survival, they have also increased the risk of infections among SOT recipients (SOTRs), especially pneumonia. Pneumonia remains one of the leading causes of morbidity and mortality, with respiratory infections contributing to 30-70% of deaths in SOTRs, depending on the organ transplanted and the timing of infection. This review summarizes current knowledge on the epidemiology, risk factors, microbial etiology, and clinical manifestations of pneumonia in SOTRs. Temporal patterns of infection are also explored, with early post-transplant infections frequently caused by nosocomial or donor-derived pathogens, and community-acquired infections predominating beyond 6-12 months post-transplantation. The lack of robust, SOT-specific guidelines for pneumonia complicates the management of this entity in SOTRs. Most recommendations are based on extrapolations from immunocompetent populations. Furthermore, the lack of large, prospective trials comparing empirical antibiotic strategies in SOTRs limits evidence-based decision-making. Despite these challenges, early initiation of empirical therapy remains crucial to improving outcomes. The review highlights the importance of timely microbiological diagnosis, individualized antimicrobial stewardship, and targeted therapeutic approaches in the context of increasing antimicrobial resistance. Incorporating local epidemiological data and patient-specific risk profiles may enhance the accuracy of diagnosis and support de-escalation of therapy upon pathogen identification.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138669","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}