{"title":"Alcohol use disorders and pneumonia: susceptibility and severity.","authors":"Asad J Gandapur, Todd A Wyatt","doi":"10.1080/17476348.2025.2560201","DOIUrl":"10.1080/17476348.2025.2560201","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol use disorder (AUD) represents a major public health issue that produces far-reaching physiological effects. AUD is an underappreciated, yet critical risk factor clinicians need to be aware of and screen for to integrate preventive and therapeutic strategies when dealing with pneumonia in this vulnerable population. This research paper investigates the link between AUD and pneumonia by examining both the elevated risk of lung infection and the intensified disease severity.</p><p><strong>Areas covered: </strong>The available epidemiological data show that people with AUD experience elevated rates of both community-acquired and hospital-acquired pneumonia. This review examines the detailed mechanisms of AUD as suggested by current research findings. For this purpose, a comprehensive literature search was conducted in PubMed between 1785 and 2025. Open Evidence was also used as a search engine to look for specific papers addressing a specific question of interest.</p><p><strong>Expert opinion: </strong>These studies indicate that alcohol consumption makes people more prone to infections through various mechanisms. Alcohol-related comorbidities exacerbate pneumonia outcomes, resulting in elevated hospitalization rates, intensive care unit (ICU) admissions, and patient deaths. This review emphasizes the need for combined healthcare strategies that treat substance use disorders together with measures to prevent infection risks to improve patient outcomes.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimally invasive surgical approaches for pneumothorax: evolution and current perspectives.","authors":"Teruaki Mizobuchi, Yuki Ito, Akimu Sobue, Yuki Tada, Kaoru Nagato, Takayoshi Yamamoto","doi":"10.1080/17476348.2025.2559439","DOIUrl":"https://doi.org/10.1080/17476348.2025.2559439","url":null,"abstract":"<p><strong>Introduction: </strong>PubMed was used for a literature search (1990-2025) on the minimally invasive surgical approaches for pneumothorax, which have evolved markedly, with video-assisted thoracic surgery (VATS) emerging as a preferred procedure. Systematic reviews of randomized control trials indicate that VATS is less invasive than traditional thoracotomy. Furthermore, uniportal VATS provides less postoperative pain and better cosmetic outcomes than thoracotomy. Currently, uniportal VATS seems preferred as the minimally invasive surgical approach for pneumothorax. New devices such as small-diameter thoracoscopes and forceps, which are used in uniportal subxiphoid VATS and uniportal subcostal robot-assisted thoracic surgery, may contribute to reducing the postoperative incidence of intercostal neuralgia and enhancing satisfaction with the cosmetic results.</p><p><strong>Areas covered: </strong>The ideal surgical approaches for pneumothorax, referencing guidelines, and studies from various countries.</p><p><strong>Expert opinion: </strong>This review explores various aspects of minimally invasive surgical approaches for pneumothorax. Uniportal VATS for pneumothorax via the intercostal approach is commonly performed worldwide and ensures high surgical quality. This review discusses what should be performed within the thoracic cavity to reduce the postoperative recurrence rate of pneumothorax, problems associated with thoracic adhesions that may be disadvantageous for pneumothorax patients in the future, and the latest surgical approaches that may become mainstream.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Misbah Baqir, Allison M LeMahieu, Thomas E Hartman, Wigdan H Farah, Eunhee E Yi, Jay H Ryu
{"title":"Pleuroparenchymal fibroelastosis: review of 81 cases.","authors":"Misbah Baqir, Allison M LeMahieu, Thomas E Hartman, Wigdan H Farah, Eunhee E Yi, Jay H Ryu","doi":"10.1080/17476348.2025.2555079","DOIUrl":"10.1080/17476348.2025.2555079","url":null,"abstract":"<p><strong>Background: </strong>Pleuroparenchymal fibroelastosis (PPFE) is an upper lobe - predominant interstitial pneumonia pattern that can be idiopathic or secondary and has unclear clinical characteristics, disease course, and prognostic factors. This study analyzed PPFE patient characteristics, identified mortality predictors, and compared disease progression between idiopathic and secondary PPFE.</p><p><strong>Research design and methods: </strong>We retrospectively identified patients with PPFE and analyzed demographic, clinical, radiologic, and pathologic data. Linear regression mixed models were used to assess predictors of mortality and lung function decline.</p><p><strong>Results: </strong>Among 81 patients identified, 73% were women, median age was 69.4 years, and 75% were nonsmokers. Idiopathic PPFE comprised 46% of cases; secondary PPFE was most commonly familial (40%) or autoimmune related (33%). Over a median follow-up of 777 days, 38% died; the 5-year survival rate was 53%. Mortality risk did not differ between idiopathic and secondary PPFE. Lower body mass index, lower forced vital capacity (FVC) at diagnosis, and smoking history predicted mortality. The decline in FVC was slower in idiopathic PPFE than secondary PPFE.</p><p><strong>Conclusions: </strong>Idiopathic and secondary PPFE differ in FVC decline but not in mortality risk. Familial and autoimmune conditions are the most common secondary causes.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Take a deep breath: the important role of vitamin A in neonatal lung development and visiting the potential of aerosolized delivery for bronchopulmonary dysplasia prevention.","authors":"Virender K Rehan, Craig A Gelfand, Robert Segal","doi":"10.1080/17476348.2025.2554427","DOIUrl":"10.1080/17476348.2025.2554427","url":null,"abstract":"","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-4"},"PeriodicalIF":2.7,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rituximab treatment for connective tissue diseases associated-pulmonary hypertension: a systematic literature review.","authors":"Amany Touil, Selma Bouden, Sarra Maazaoui, Leila Rouached, Aicha Ben Tekaya, Siwar Ben Dhia, Ines Mahmoud, Rawdha Tekaya, Olfa Saidane, Leila Abdemloula","doi":"10.1080/17476348.2025.2557634","DOIUrl":"https://doi.org/10.1080/17476348.2025.2557634","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the efficacy and safety of Rituximab (RTX) in the treatment of pulmonary hypertension (PH) in patients with connective tissue diseases (CTDs).</p><p><strong>Methods: </strong>A systematic review of the published literature was performed according to the PRISMA guidelines. Eligible articles were clinical trials, cohort studies, case series, and case reports of adult patients with CTD-PH treated with RTX. The selected languages were English and French.</p><p><strong>Results: </strong>Six studies fulfilled the selection criteria and two of them were prospective. Most patients were from the U.S.A. and Russia. The predominant sex was female (85.9%), and the age of the included patients ranged from 29 years to 67 years. PH was confirmed by right heart catheterization in 3 studies. The CTDs associated with PH were systemic sclerosis (3 cases), adult-onset Still's disease (one case), systemic lupus erythematosus (one case) and mixed connective tissue disease (one case). The mean number of infusions was 4.2. The mean follow-up period across all studies was 18.3 months. Clinical and paraclinical parameters before and after RTX infusions were evaluated and showed improvement. RTX for the treatment of CTD-PH appeared to be well tolerated.</p><p><strong>Conclusions: </strong>RTX seemed to be effective and safe in the treatment of CTD-PH.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"New insights into the treatment of asthma complicated by allergic bronchopulmonary aspergillosis.","authors":"Ritesh Agarwal, Valliappan Muthu, Inderpaul Singh Sehgal","doi":"10.1080/17476348.2025.2517302","DOIUrl":"10.1080/17476348.2025.2517302","url":null,"abstract":"<p><strong>Introduction: </strong>Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder that arises in individuals with asthma or cystic fibrosis due to an exaggerated immune response to <i>Aspergillus fumigatus</i>. It leads to mucus plugging, recurrent exacerbations, and progressive bronchiectasis. Despite established diagnostic criteria, ABPA remains underdiagnosed, primarily due to its overlap with severe asthma and limited clinical awareness. Evolving insights into immunopathogenesis and the emergence of targeted therapies have begun to transform the management of ABPA.</p><p><strong>Areas covered: </strong>We discuss the current evidence on immunopathogenesis, treatment, and monitoring of ABPA in asthma. The review covers established and emerging therapies, including systemic glucocorticoids, oral triazoles (such as itraconazole), inhaled antifungals, and biological agents. We provide practical guidance for initiating treatment based on disease phenotype and discuss treatment monitoring using clinical symptoms, serum biomarkers, chest imaging, and lung function tests.</p><p><strong>Expert opinion: </strong>The management of ABPA is poised for a paradigm shift toward precision medicine. Future strategies will likely be driven by international registries, biomarker discovery using omics-based platforms, and the identification of endotype- and phenotype-specific treatments. Randomized trials comparing biologic therapies, combination approaches using antifungals and biologics, and the development of inhaled antifungal delivery systems are likely to reshape the management of ABPA.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"967-979"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of different pulmonary rehabilitation approaches on fibrotic interstitial lung disease: a comparative randomized trial.","authors":"Esra Pehlivan, Erdoğan Çetinkaya, Fulya Senem Karaahmetoğlu, Zeynep Betül Özcan, Kürşad Nuri Baydili, Barış Demirkol, Halit Çınarka, Ramazan Eren, Amine Ataç","doi":"10.1080/17476348.2025.2513512","DOIUrl":"10.1080/17476348.2025.2513512","url":null,"abstract":"<p><strong>Background: </strong>Fibrosing Interstitial Lung Diseases (F-ILDs) lead to reduced exercise capacity and quality of life. Pulmonary Rehabilitation (PR) exercise programs have shown potential in improving symptoms and functional capacity in these patients. This study aimed to compare the effectiveness of different PR exercise approaches in patients with F-ILDs.</p><p><strong>Research design and methods: </strong>This randomized, three-arm controlled trial included F-ILD patients divided into three groups: hospital-based supervised(HGr), synchronized-online(SOGr) with live video calls, and video-based (VGr) with recorded exercise videos. All groups underwent an 8-week program combining aerobic and resistance training. Clinical parameters assessed included 6-minute walking distance(6MWD), modified medical research council dyspnea score(mMRC), respiratory function tests, Saint George Respiratory Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form(IPAQ-SF), fatigue severity scale (FSS), and muscle strength.</p><p><strong>Results: </strong>Of the 75 patients, 65 completed the study, with comparable demographic and baseline characteristics. Significant improvements in 6MWD, mMRC, maximal inspiratory pressure, IPAQ-SF, SGRQ, and peripheral muscle strength were seen in all groups. Post-hoc analysis showed HGr had greater improvements in forced vital capacity and FSS compared to SOGr.</p><p><strong>Conclusion: </strong>Hospital-based, synchronized-online, and video-based PR programs all improve clinical outcomes in patients with F-ILDs. However, supervised in-hospital PR yielded greater benefits in lung function and fatigue reduction compared to the online approaches.</p><p><strong>Clinicaltrial registration: </strong>https://clinicaltrials.gov/study/NCT05166057.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1027-1035"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helena Buso, Giulia A M L Costanzo, Nicola Monaco, Nicholas Landini, Davide Firinu, Marcello Rattazzi, Francesco Cinetto, Cinzia Milito
{"title":"An update on appropriate lung management in patients with primary antibody deficiencies.","authors":"Helena Buso, Giulia A M L Costanzo, Nicola Monaco, Nicholas Landini, Davide Firinu, Marcello Rattazzi, Francesco Cinetto, Cinzia Milito","doi":"10.1080/17476348.2025.2517299","DOIUrl":"10.1080/17476348.2025.2517299","url":null,"abstract":"<p><strong>Introduction: </strong>Predominantly antibody deficiencies (PADs) represent the most common inborn errors of immunity (IEIs), constituting over 50% of all IEIs detected globally. Compared to other IEIs, PADs are linked to a more favorable long-term prognosis and are typically diagnosed in adulthood. We analyzed the most recent literature on lung involvement in PAD using PUBMED Central.</p><p><strong>Areas covered: </strong>PADs are characterized by their impact on the respiratory system, which results in significant morbidity and mortality due to the impairment of both humoral and mucosal immune responses. This impact leads to a broad spectrum of complications that could be infection-related, inflammatory, or neoplastic.</p><p><strong>Expert opinion: </strong>Defined guidelines are unavailable, but a strict assessment of pulmonary status should be recommended in patients with characteristic immunologic patterns (low IgA serum level, reduced percentage of switched memory B cells, increased IgM serum levels, increased percentage of CD21 low B cells, autoimmune cytopenia, and splenomegaly).</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"981-996"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Respiratory post COVID sequelae: the role of pulmonary function impairment, fatigue and obesity in dyspnea and the impact of SPA rehabilitation.","authors":"Emanuela Resta, Chiara Noviello, Preethymol Peter, Giusi Graziano, Valeria Dalena, Alessia Caputi, Giorgio Castellana, Giacomo Riformato, Silvio Tafuri, Pierucci Pierucci","doi":"10.1080/17476348.2025.2516801","DOIUrl":"10.1080/17476348.2025.2516801","url":null,"abstract":"<p><strong>Background: </strong>Respiratory COVID-19 post-acute sequelae (PASC) may persist for extended periods following recovery.</p><p><strong>Methods: </strong>Patients with PASC who were referred for Salus Per Aquam (SPA) therapy were enrolled in the study.</p><p><strong>Aim: </strong>To categorize patients based on the presence of dyspnea and fatigue, with a specific focus on obesity, chronic respiratory conditions, and predictors of rehabilitation outcomes.</p><p><strong>Results: </strong>From July-November 2021, 327 consecutive patients were enrolled at the spa center. Among these, 31% had been previously hospitalized, 5% had required noninvasive or invasive mechanical ventilation. Approximately one-third of the cohort underwent DLCO testing, which was abnormal in 56.3% of cases. Patients with impaired DLCO had significantly higher dyspnea rates compared to those with normal DLCO (88.9% vs. 64.3%, <i>p</i> < 0.0001). Dyspneic patients were more likely to have one or more comorbidities (<i>p</i> < 0.001), be obese (<i>p</i> = 0.005), and have a history of chronic respiratory disease (<i>p</i> = 0.0009). Patients reporting fatigue also had higher rates of dyspnea (91.2% vs. 61.5%, <i>p</i> < 0.0001), were more frequently obese (<i>p</i> = 0.03), had more comorbidities (<i>p</i> = 0.02), and had a greater history of hospitalization (<i>p</i> = 0.02). No improvement in dyspnea/fatigue was observed post-SPA treatment among patients with DLCO impairment and obese. However, patients with chronic respiratory conditions reported benefit.</p><p><strong>Conclusions: </strong>Dyspnea in PASC is complex and multifactorial. The findings suggest that SPA rehabilitation may be particularly beneficial for alleviating fatigue and enhancing overall well-being in selected subgroups of patients with PASC.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1017-1026"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Bondeelle, Guang-Shing Cheng, Anne Bergeron
{"title":"What's new in the management of pulmonary complications in allogeneic stem cell transplantation?","authors":"Louise Bondeelle, Guang-Shing Cheng, Anne Bergeron","doi":"10.1080/17476348.2025.2513519","DOIUrl":"10.1080/17476348.2025.2513519","url":null,"abstract":"<p><strong>Introduction: </strong>As survival increases after allogeneic hematopoietic stem cell transplantation (allo-HCT), several organ complications have emerged, including those involving the lung, which require a multidisciplinary management approach. The constant evolution of allo-HCT procedures, advances in diagnostic tools for infections and pulmonary disease, as well as new treatment approaches, require frequent updating of knowledge in this field.</p><p><strong>Areas covered: </strong>We review the multiple infectious and noninfectious lung complications that occur both early and late after allo-HCT. This includes an updated description of these complications, risk factors, diagnostic approach and outcome. A literature search was performed using PubMed-indexed journals.</p><p><strong>Expert opinion: </strong>The diagnosis of pulmonary complications after allo-HCT remains challenging, further complicated by the frequent association of co-infections and/or links between infection and noninfectious complications. The development of metagenomic next-generation sequencing (mNGS) should enhance the diagnostic yield of bronchoalveolar lavage, but its clinical relevance remains to be evaluated. A better understanding of the pathophysiology of the lung chronic graft-versus-host disease (GVHD) and improved phenotyping are essential for advancing its diagnostic and therapeutic management. This requires a revision of diagnostic criteria and the identification of new biomarkers of early disease.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"903-923"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}