{"title":"Pah in the era of obesity: navigating phenotypes of pulmonary hypertension.","authors":"Dany Tager, Roberto J Bernardo, Adriano R Tonelli","doi":"10.1080/17476348.2026.2753850","DOIUrl":"https://doi.org/10.1080/17476348.2026.2753850","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary arterial hypertension (PAH) is a progressive vasculopathy whose phenotype has shifted over the decades from young women to older patients with cardiometabolic comorbidities. Obesity is among the most prevalent and clinically consequential of these comorbidities, affecting 24-40% of patients in contemporary PAH registries.</p><p><strong>Areas covered: </strong>We review the epidemiology of obesity and its impact on PAH; the definition of obesity and the limitations of body mass index; the effects of obesity on adipose, cardiovascular and respiratory systems; its association with health disparities; the clinical approach to the patient with obesity and suspected pulmonary hypertension (PH), including right heart catheterization with provocative maneuvers and esophageal manometry; comorbid conditions and the obesity paradox; and management, including weight loss, PAH-specific therapy, heart failure with preserved ejection fraction and sleep-disordered breathing. A literature search of PubMed/MEDLINE was performed for articles published from database inception to September 2026.</p><p><strong>Expert opinion: </strong>Obesity has implications in the origin, symptoms, diagnosis and management of PH. Accurate characterization of PH in obese patients depends first on measuring and reporting pressures that reflect true transmural hemodynamics. Incretin-based therapy and activin signaling inhibition are promising therapeutic directions, but dedicated trials in patients with obesity and pulmonary hypertension are needed.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240856","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}
Minenhle S Buthelezi, Prakash Jeena, Rajen N Naidoo
{"title":"Heat and childhood respiratory health: exploring the evidence and raising the red flags.","authors":"Minenhle S Buthelezi, Prakash Jeena, Rajen N Naidoo","doi":"10.1080/17476348.2026.2749889","DOIUrl":"10.1080/17476348.2026.2749889","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change impacts on the health of vulnerable groups globally. Heat, as a specific component of climate change, affects the respiratory health of children, particularly those from marginalized communities and in low- and middle-income countries. Understanding the exposure pathways for these outcomes is critical for interventions and policy development.</p><p><strong>Areas covered: </strong>A synthesis of the evidence for key heat-related childhood respiratory outcomes (asthma, infections, rhinitis and lung function) is presented. The knowledge gaps are highlighted. Interpreting the evidence requires understanding the approaches to heat exposure characterization in epidemiological studies. These exposure-response complexities are explored.</p><p><strong>Expert opinion: </strong>While the evidence for heat-related adverse events among children with asthma and respiratory infections is strong, it is less so for other respiratory outcomes. Inconsistencies exist across studies. These inconsistencies may be a result of how exposure is characterized in studies. While acute outcomes have been investigated mostly from hospital records, sub-clinical effects among children in community-based studies are absent. Limited studies have been conducted in marginalized communities or in low- and middle-income countries. Understanding exposure-response relationships and addressing gaps in the evidence is necessary for the development of appropriate interventions to protect the respiratory health of children.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-16"},"PeriodicalIF":2.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187002","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":"Preserved ratio impaired spirometry: implications for clinical practice.","authors":"Angelica Tiotiu","doi":"10.1080/17476348.2026.2744435","DOIUrl":"https://doi.org/10.1080/17476348.2026.2744435","url":null,"abstract":"","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-4"},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120685","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}
Alice Laffi, Valentina Veronesi, Riccardo Papa, Mauro Papotti, Angelica Sonzogni, Fabrizio Bianchi, Giuseppe Pelosi
{"title":"Ki-67 antigen in lung carcinoids/neuroendocrine tumors: from a proliferation marker to a clinical compass.","authors":"Alice Laffi, Valentina Veronesi, Riccardo Papa, Mauro Papotti, Angelica Sonzogni, Fabrizio Bianchi, Giuseppe Pelosi","doi":"10.1080/17476348.2026.2744440","DOIUrl":"https://doi.org/10.1080/17476348.2026.2744440","url":null,"abstract":"<p><strong>Introduction: </strong>Ki-67 has extensively been studied in lung neuroendocrine tumors (NETs), including typical and atypical carcinoid, yet it has never been formally accepted into classification. Its clinical application was limited to the differential diagnosis toward neuroendocrine carcinomas and the characterization of carcinoids with increased proliferation rates. Recently, the International Association for the Study of Lung Cancer (IASLC) has released a novel grading-based classification, in which Ki-67 pays a central and decisional role.</p><p><strong>Areas covered: </strong>This review examines the role of Ki-67 in lung NETs from three complementary perspectives (available English literature in PubMed, National Library of Medicine): (i) methodological issues, specimen types, grading-based classification, and molecular correlations; (ii) impact of statistical methods on study findings; (iii) clinical implications of a grading-based classification for diagnostic phase, hereditary syndromes, and therapeutic decision-making.</p><p><strong>Expert opinion: </strong>The proposed grading-driven classification is likely to reshape established concepts and practices in the field of lung NETs, in future classifications. An awareness of the strengths and limitations of statistical methods used to define the distribution and significance of Ki-67 is essential for generating reliable, reproducible, and clinically meaningful evidence.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120532","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}
Maria Luiza Ferreira Vicente, Ana Flavia Gomes, Alejandra Estela Miranda, Francisco Eduardo Gontijo Guimarães, Ana Paula Cremasco Takano, Gabriel Henrique Rodella Guedes, Paulo Hilário Nascimento Saldiva, Mariana Matera Veras
{"title":"Pulmonary black carbon accumulation: mechanisms, health impacts, and environmental sources.","authors":"Maria Luiza Ferreira Vicente, Ana Flavia Gomes, Alejandra Estela Miranda, Francisco Eduardo Gontijo Guimarães, Ana Paula Cremasco Takano, Gabriel Henrique Rodella Guedes, Paulo Hilário Nascimento Saldiva, Mariana Matera Veras","doi":"10.1080/17476348.2026.2740205","DOIUrl":"https://doi.org/10.1080/17476348.2026.2740205","url":null,"abstract":"<p><strong>Introduction: </strong>Black carbon (BC), a major component of combustion-derived particulate matter, contributes substantially to air pollution and climate change and is increasingly recognized as a biologically active particle capable of crossing biological barriers and accumulating in human tissues. This review examines the evolution of BC exposure and its emerging relevance as a biomarker of cumulative internal dose.</p><p><strong>Areas covered: </strong>We review the historical sources, physicochemical properties, atmospheric behavior, exposure assessment, biodistribution, tissue retention, detection methods, and health effects of BC. Particular emphasis is placed on tissue-based biomonitoring, label-free optical detection, and evidence linking BC exposure to respiratory, cardiovascular, neurological, developmental, metabolic, gastrointestinal, and immunological effects. PubMed, Web of Science, Google Scholar, and Scopus were searched for studies published through June 2026, including epidemiological, experimental, mechanistic, and biomonitoring investigations.</p><p><strong>Expert opinion: </strong>Tissue-based BC biomonitoring may bridge external exposure assessment and biologically effective internal dose. Its integration with exposome research and precision environmental health could improve individual exposure characterization, identify susceptible populations, and strengthen environmental prevention strategies.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120705","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":"A profile on inhaled treprostinil for pulmonary hypertension.","authors":"Karim El-Kersh, Nafis Shamsid-Deen","doi":"10.1080/17476348.2026.2694798","DOIUrl":"10.1080/17476348.2026.2694798","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary hypertension (PH) remains a progressive and life-threatening disease despite advances in therapies targeting multiple signaling pathways. Prostacyclin analogues play a central role in treatment; however, systemic formulations can be limited by treatment burden and systemic adverse effects. Inhaled treprostinil has emerged as an important prostacyclin-pathway therapy that allows targeted pulmonary artery vasodilation while minimizing systemic exposure, with relevance for pulmonary arterial hypertension (PAH) and PH associated with interstitial lung disease (PH-ILD).</p><p><strong>Areas covered: </strong>This review provides a comprehensive overview of the pharmacology, pharmacokinetics, and clinical development of inhaled treprostinil across both currently available and investigational formulations. All major clinical trials are examined, including pivotal early Phase I-II investigations. We discuss all commercially available and emerging delivery platforms including nebulized, dry-powder, liposomal, and prodrug formulations. In addition, the review addresses safety, real-world utilization, regulatory status, and the evolving therapeutic and commercial landscape of inhaled prostacyclin therapy.</p><p><strong>Expert opinion: </strong>Inhaled treprostinil has become a key treatment option in PH-ILD and PAH management. Continued development of longer-acting formulations and improved delivery systems may enhance adherence and expand its clinical role. Emerging evidence suggesting potential antifibrotic effects raises the possibility that inhaled treprostinil could influence disease progression in pulmonary fibrosis, potentially broadening its therapeutic applications in the coming years.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1153-1165"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304360","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":"Improving the follow-up of children and adults with prematurity-associated lung disease.","authors":"Christopher William Course, Sailesh Kotecha","doi":"10.1080/17476348.2026.2699460","DOIUrl":"10.1080/17476348.2026.2699460","url":null,"abstract":"<p><strong>Introduction: </strong>With advances in neonatal care over the last three decades leading to improved survival from preterm birth, it is becoming increasingly evident that preterm-born individuals experience respiratory morbidity and reduced lung function through the life course, now termed prematurity-associated lung disease (PLD), with increasing concern regarding the onset of chronic obstructive pulmonary disease in early adult life.</p><p><strong>Areas covered: </strong>In this article, we will cover the current evidence for screening, monitoring, and management of PLD. We shall discuss monitoring strategies utilizing lung function testing, lung imaging, and oximetry, among others. Although current data regarding optimal management and treatment are limited, we shall discuss pharmacological and non-pharmacological methods currently for PLD.</p><p><strong>Expert opinion: </strong>It is now clear that long-term respiratory follow-up for high-risk preterm-born individuals is imperative to identify PLD early, monitor its progress, and optimize respiratory outcomes. There must be increased recognition from pediatric and adult physicians of the impact of prematurity and low birth weight on respiratory health in later life, with services developed to transition individuals with PLD from pediatric to adult care. Future research should aim to improve understanding of PLD phenotypes and phenotype-targeted interventions to optimize respiratory health in PLD across the life course.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1167-1182"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378572","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":"Upper and lower airway crosstalk in acute exacerbations of COPD: a clinical and biological overview.","authors":"Simone Ielo, Lorenzo Carriera, Pier-Valerio Mari, Roberto Barone, Francesca Cefaloni, Antonella Loperfido, Angelo Coppola, Stefano Baglioni, Eugenio De Corso, Raffaele Scala","doi":"10.1080/17476348.2026.2699459","DOIUrl":"10.1080/17476348.2026.2699459","url":null,"abstract":"<p><strong>Introduction: </strong>Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are acute worsening events characterized by increased dyspnea, cough, and sputum production. Although traditionally viewed as lower airway events, growing evidence suggests that AE-COPD may reflect broader pan-airway dysfunction involving both upper and lower respiratory compartments.</p><p><strong>Areas covered: </strong>This overview examines upper - lower airway crosstalk in AE-COPD across three domains: pan-airway inflammation, epithelial alarmin/cytokine networks, and the continuous airway microbiome. We discuss the coexistence of COPD with sinonasal inflammation, chronic rhinitis, and chronic rhinosinusitis, and their possible contribution to symptom burden, impaired quality of life, and exacerbation risk. We also review mechanisms linking upper and lower airways, including epithelial barrier dysfunction, impaired antiviral responses, innate immune activation, alarmin release, and microbiome-driven dysbiosis.</p><p><strong>Expert opinion: </strong>Recognizing AE-COPD as a manifestation of pan-airway dysfunction may have relevant clinical implications. Systematic assessment of upper airway symptoms and comorbidities could improve phenotyping, risk stratification, and therapeutic targeting, particularly in frequent exacerbators. Future longitudinal and multi-omic studies are needed to validate upper airway biomarkers and determine whether targeted treatment of upper airway disease can modify COPD outcomes.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1183-1191"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393094","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}
Ghadah A Alrehaili, Wigdan H Farah, Mohamed Abusalih, Neha Ramachandran, Ahmed Salim, Livia F Kruger, Akshay Kohli, Misbah Baqir
{"title":"Role of myositis autoantibodies in diagnosing interstitial lung disease in patients with idiopathic inflammatory myopathies: a retrospective analysis.","authors":"Ghadah A Alrehaili, Wigdan H Farah, Mohamed Abusalih, Neha Ramachandran, Ahmed Salim, Livia F Kruger, Akshay Kohli, Misbah Baqir","doi":"10.1080/17476348.2026.2684330","DOIUrl":"10.1080/17476348.2026.2684330","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic inflammatory myopathies (IIMs) are frequently complicated by interstitial lung disease (ILD). The independent clinical significance of myositis autoantibody positivity remains incompletely defined.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients undergoing myositis autoantibody testing at a single tertiary center (1997-2022). Multivariable logistic regression assessed the association between antibody positivity and ILD. Subgroup analyses evaluated clinical phenotypes and radiologic patterns.</p><p><strong>Results: </strong>Among 1,034 patients included in the analysis, 359 (34.7%) were positive for at least one myositis autoantibody and 365 (35.5%) had ILD. Antibody-positive patients were younger, more frequently female, and had a higher prevalence of ILD compared to antibody-negative patients (41.2% vs. 32.2%, <i>p</i> < 0.01). Myositis autoantibody positivity was independently associated with ILD (adjusted OR 1.78, 95% CI 1.33-2.37, <i>p</i> < 0.001). Increasing age, higher BMI, former smoking status, and Asian ethnicity were also associated with ILD. Among patients with ILD, antibody-positive individuals had a higher prevalence of systemic autoimmune features, including Raynaud's phenomenon, arthritis, and mechanic's hands, as well as higher inflammatory markers and more impaired pulmonary function.</p><p><strong>Conclusion: </strong>Myositis autoantibody positivity is independently associated with ILD and identifies a distinct clinical phenotype. These findings should be interpreted in the context of the study's retrospective, single-center design.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1223-1233"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159491","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}
Shun Nakahara, Maria Júlia Hallack Moura, Sumeyye K Cengiz, Manoel F Filho, Jafar Aljazeeri
{"title":"Effect of depemokimab on asthma control and clinical outcomes: a systematic review and meta-analysis of randomized controlled trials.","authors":"Shun Nakahara, Maria Júlia Hallack Moura, Sumeyye K Cengiz, Manoel F Filho, Jafar Aljazeeri","doi":"10.1080/17476348.2026.2688299","DOIUrl":"10.1080/17476348.2026.2688299","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with eosinophilic asthma are at increased risk of poor asthma control despite optimized standard therapy. Depemokimab, a novel long-acting anti-interleukin-5 monoclonal antibody, has shown efficacy in reducing exacerbations; however, its effects across clinical outcomes have not been comprehensively synthesized.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane databases, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing depemokimab with placebo. Outcomes included Asthma Control Questionnaire-5 (ACQ-5), asthma exacerbation rate, quality of life assessed by St. George's Respiratory Questionnaire (SGRQ), and adverse events. Results were reported as mean differences (MDs) or incidence rate ratios (IRRs) with 95% confidence intervals (CIs), and heterogeneity was assessed using the I<sup>2</sup> statistic.</p><p><strong>Results: </strong>Four RCTs (<i>n</i> = 954) were included. Depemokimab did not significantly improve ACQ-5 (MD -0.30; 95% CI -0.92 to 0.32; I<sup>2</sup> = 73.6%; <i>p</i> = 0.23), but reduced exacerbation rates (IRR 0.47; 95% CI 0.36 to 0.59; I<sup>2</sup> = 0%; <i>p</i> < 0.001) and modestly improved SGRQ scores without reaching the MCID (MD -2.80; 95% CI -5.38 to -0.23; I<sup>2</sup> = 0.0%; <i>p</i> = 0.033). Safety was comparable to placebo.</p><p><strong>Conclusions: </strong>Depemokimab reduced exacerbations and had a comparable safety profile, but did not improve symptom control or achieve the MCID for health-related quality-of-life.</p><p><strong>Registration: </strong>The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420261282685).</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1215-1221"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213807","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}