IF 4.5

Breathe Pub Date : 2026-05-23 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0090-2026

Shan Kai Ing, Yih Hoong Lee, Brandon Sing Ann Heu, Muhammad Habib Nasution Bin Zulpan Nasution, Nga Hung Ngu, Hock Gin Teo, Jennie Geok Lim Tan, Whilmore Anak Johin, Roziasyazni Binti Che Abdul Aziz, Sze Shyang Kho

引用次数: 0

Where are we with biomarkers in paediatric asthma in 2026? 2026年儿科哮喘的生物标志物进展如何？

IF 4.5

Breathe Pub Date : 2026-05-23 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0202-2025

Jui Andharia, Prasad Nagakumar

{"title":"Where are we with biomarkers in paediatric asthma in 2026?","authors":"Jui Andharia, Prasad Nagakumar","doi":"10.1183/20734735.0202-2025","DOIUrl":"10.1183/20734735.0202-2025","url":null,"abstract":"Paediatric asthma is a heterogenous clinical syndrome where objective tests aid, but do not replace, clinical judgment. In 2026, the challenge is determining which biomarkers and tests are most informative for different patients and purposes. This review summarises current evidence supporting key diagnostic and monitoring tools for childhood asthma (age 5-16 years): exhaled nitric oxide fraction (F ENO), spirometry with bronchodilator reversibility (BDR), and additional investigations such as peak expiratory flow variability, blood eosinophils, allergen sensitisation and bronchial challenge. Recent British Thoracic Society/National Institute for Health and Care Excellence/Scottish Intercollegiate Guidelines Network and European Respiratory Society guidelines emphasise the need for objective confirmation of asthma, but differ in the degree of diagnostic certainty and test prioritisation. F ENO is now the leading inflammatory biomarker in routine paediatric care, valued for its noninvasive nature, ease and high specificity at elevated thresholds, especially for type 2 asthma. Its sensitivity, however, is modest, so it should not be relied upon as a stand-alone rule-out test. Spirometry remains a core physiological assessment, although its diagnostic accuracy alone is limited, and evidence supporting BDR thresholds in children is not robust. Additional tests should be used selectively, particularly when initial investigations are negative, discordant or technically challenging, or when severe asthma requires phenotype driven therapy. Biomarkers also play an important role in monitoring and severe asthma care, including predicting response to biologics. Emerging approaches like breathomics, alarmin-based biomarkers, and multi-omic profiling are discussed. Overall, biomarkers have enhanced the precision of paediatric asthma assessment, especially in severe cases, but their greatest value is in complementing, not replacing, thorough clinical evaluation.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"22 2","pages":"250202"},"PeriodicalIF":4.5,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Elevated D _LCO and pulmonary function evolution during treatment in a patient with hyperleukocytosis and leukostasis. 白细胞增多和白细胞淤积患者治疗期间的LCO升高和肺功能演变。

IF 4.5

Breathe Pub Date : 2026-05-23 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0316-2025

Santiago C Arce, Paula M Monti, Verónica B Cortés Guerrieri

引用次数: 0

The price of immune awakening: bridging knowledge gaps in checkpoint inhibitor-related pneumonitis in lung cancer. 免疫觉醒的代价：弥合肺癌中检查点抑制剂相关肺炎的知识差距

IF 4.5

Breathe Pub Date : 2026-05-23 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0326-2025

Guido Marchi

{"title":"The price of immune awakening: bridging knowledge gaps in checkpoint inhibitor-related pneumonitis in lung cancer.","authors":"Guido Marchi","doi":"10.1183/20734735.0326-2025","DOIUrl":"10.1183/20734735.0326-2025","url":null,"abstract":"Immune checkpoint inhibitors have transformed lung cancer therapy, offering durable tumour control and improved survival. Yet their success has revealed a paradox: checkpoint inhibitor-related pneumonitis (CIP), an unpredictable immune-mediated complication that can damage the lungs. CIP differs from cytotoxic therapy-induced pneumonitis, arising from immune dysregulation rather than direct tissue injury, and presents with diverse clinical and radiological patterns. Incidence ranges from 2.5% in trials to nearly 20% in real-world practice, reflecting biological variability and inconsistent recognition. This viewpoint reviews persistent gaps in understanding CIP, including mechanisms, risk prediction, early detection, and management. CIP appears multifactorial, involving T-cell-driven inflammation, age-related immune changes, and possible environmental or infectious triggers. Risk stratification remains limited, although emerging biomarkers and tumour- or therapy-related factors show potential. Diagnosis relies primarily on exclusion, supported by imaging and bronchoalveolar lavage. Investigational tools, including radiomics and artificial intelligence, demonstrate potential to detect subclinical changes and classify CIP patterns, offering promise for earlier and more objective recognition in the future. Addressing these gaps requires prospective, multidisciplinary research, standardised frameworks, and collaborative registries. CIP represents both a clinical challenge and a scientific opportunity: understanding its mechanisms and improving early recognition may optimise immunotherapy safety, efficacy, and ultimately patient survival and quality of life.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"22 2","pages":"250326"},"PeriodicalIF":4.5,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rigid bronchoscopy is the gold standard management of inhaled foreign bodies in children: myth or maxim? 刚性支气管镜检查是治疗儿童吸入异物的金标准：神话还是格言？

IF 4.5

Breathe Pub Date : 2026-05-23 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0039-2026

Simon Cole, Sophie Wilkinson, Haytham Kubba

引用次数: 0

The metabolic code of pulmonary disease: from mechanisms to therapeutic opportunities. 肺部疾病的代谢密码：从机制到治疗机会。

IF 4.5

Breathe Pub Date : 2026-05-18 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0260-2025

Ella Kearney, Sze-Ying Tan, Zhuowen Wang, Catríona M Dowling

引用次数: 0

The diagnostic journey of a young adult with recurrent infections and progressive dyspnoea. 诊断之旅的年轻成人复发性感染和进行性呼吸困难。

IF 4.5

Breathe Pub Date : 2026-05-18 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0330-2025

Vinay Venugopal, Saurabh Karmakar, Gaurav Kumar Singh, Debapriya Maji, Alpana Srivastava, Jinit Rakeshbhai Soni

引用次数: 0

Molecules in pulmonary medicine. 肺医学中的分子。

IF 4.5

Breathe Pub Date : 2026-05-18 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0122-2026

Imran Sulaiman

引用次数: 0

Artificial intelligence for pleural effusion and pneumothorax detection on thoracic ultrasound: an educational viewpoint on the promise, pitfalls and path forward. 人工智能在胸腔超声胸膜积液和气胸诊断中的应用前景、缺陷和发展方向。

IF 4.5

Breathe Pub Date : 2026-05-18 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0002-2026

Guido Marchi

{"title":"Artificial intelligence for pleural effusion and pneumothorax detection on thoracic ultrasound: an educational viewpoint on the promise, pitfalls and path forward.","authors":"Guido Marchi","doi":"10.1183/20734735.0002-2026","DOIUrl":"10.1183/20734735.0002-2026","url":null,"abstract":"Thoracic ultrasound (TUS) is a key bedside tool for detecting pleural effusion and pneumothorax, offering high sensitivity, portability and radiation-free assessment. However, its reliability is limited by operator dependency and variable training, posing challenges in emergency, intensive care and resource-limited settings. Artificial intelligence (AI) has emerged as a potential adjunct to support TUS interpretation, with deep learning algorithms showing promising accuracy in research studies. Evidence suggests AI may perform well for straightforward cases, yet performance declines significantly during external validation and for complex or low-quality images, precisely where clinical decision support is most needed. Five potential scenarios for AI application are identified: emergency triage, intensive care unit monitoring, post-procedural safety checks, deployment in resource-limited environments, and educational feedback for trainees. Despite these opportunities, current AI systems remain immature: methodological limitations, operator-dependence and lack of real-world outcome data constrain safe clinical adoption. Rigorous prospective trials, multisite validation, standardised reporting, and integration of quality assurance are essential before routine use. At present, AI-assisted TUS should be regarded as a research and educational tool rather than a substitute for clinical judgment. Thoughtful development and cautious implementation are required to transform AI from an experimental promise into a reliable, patient-centred clinical resource.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"22 2","pages":"260002"},"PeriodicalIF":4.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Immune checkpoints in lung cancer. 肺癌的免疫检查点

IF 4.5

Breathe Pub Date : 2026-05-18 eCollection Date: 2026-04-01 DOI: 10.1183/20734735.0244-2025

Eva María Garrido-Martín, Milica Kontic, Claire Rooney, Nahal Mansouri

{"title":"Immune checkpoints in lung cancer.","authors":"Eva María Garrido-Martín, Milica Kontic, Claire Rooney, Nahal Mansouri","doi":"10.1183/20734735.0244-2025","DOIUrl":"10.1183/20734735.0244-2025","url":null,"abstract":"The advent of immune checkpoint inhibitors (ICIs) has revolutionised the management of lung cancer, transforming it from a historically immune-resistant malignancy into a paradigm for durable immunotherapy response. This review provides a comprehensive overview of the biological and clinical foundations of checkpoint regulation in the lung and their implications for patient care. We first explore the unique pulmonary immune environment, where continuous exposure to environmental antigens necessitates a delicate balance between tolerance and defence. Within this context, immune checkpoints, such as programmed cell death protein 1 (PD-1) and its ligand PD-L1 as well as cytotoxic T-lymphocyte-associated protein 4, maintain physiological self-tolerance but can be subverted by tumour cells to evade immune surveillance. Emerging inhibitory receptors, including LAG-3, TIGIT and TIM-3, contribute additional layers of immune regulation and resistance, highlighting opportunities for combinatorial therapeutic strategies. The clinical section summarises pivotal trials establishing ICIs as the standard of care across metastatic, locally advanced and early-stage lung cancer. These agents now span the full disease continuum, from neoadjuvant and adjuvant to perioperative and consolidation settings. We also address the management of immune-related adverse events and the need for precision in patient selection through biomarkers, such as PD-L1 expression, tumour mutational burden and circulating immune signatures. Finally, we discuss ongoing challenges, including mechanisms of primary and acquired resistance, and emerging approaches integrating spatial multi-omics, dynamic immune monitoring and microbiome profiling. Together, these advances are reshaping lung cancer immunotherapy towards a more precise, adaptive and durable model of care.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"22 2","pages":"250244"},"PeriodicalIF":4.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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