Rodrigo de Lima Brum, Elizabet Saes-Silva, Rosália Garcia Neves, Livia da Silva Freitas, Alicia da Silva Bonifácio, Flavio Manoel Rodrigues da Silva Júnior
{"title":"Exploring climate, air pollution, and respiratory disease hospitalizations in Brazil: a scoping review.","authors":"Rodrigo de Lima Brum, Elizabet Saes-Silva, Rosália Garcia Neves, Livia da Silva Freitas, Alicia da Silva Bonifácio, Flavio Manoel Rodrigues da Silva Júnior","doi":"10.1080/17476348.2026.2736890","DOIUrl":"10.1080/17476348.2026.2736890","url":null,"abstract":"<p><strong>Introduction: </strong>Air pollution is the leading environmental risk factor for mortality worldwide, contributing to 7.9 million deaths in 2023. In Brazil, studies evaluating the combined relationship between air pollution, climate variables, and respiratory disease hospitalizations remain fragmented and regionally concentrated.</p><p><strong>Areas covered: </strong>This scoping review mapped the Brazilian literature on air pollution, climate, and respiratory hospitalizations across multiple scientific databases. A total of 1,179 studies were identified, of which 129 met the eligibility criteria after screening and full-text assessment. Respiratory infections, including pneumonia and COVID-19, followed by asthma, were the most frequently investigated outcomes, with children representing the main target population. The review also revealed geographical asymmetry, as a single federative unit concentrated more than one-third of all published studies. Overall, 117 studies (90.70%) reported positive associations between environmental exposures and hospitalizations, of which 112 reported significant results.</p><p><strong>Expert opinion: </strong>Environmental epidemiology in Brazil remains limited by methodological fragmentation, territorial inequalities, and insufficient local coverage, with only 42 municipalities (0.75% of the Brazilian municipalities) individually identified among municipal-scale studies. Although the literature establishes an important epidemiological baseline, substantial structural gaps still hinder advances in the field, reinforcing the urgent need for decentralized research strategies, methodological modernization, and integrated climate-health approaches.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003218","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}
Xin Dai, Yuxi Deng, N Sabrina Idrose, Shyamali C Dharmage, Caroline J Lodge
{"title":"HEPA air filtration for asthma and COPD: lessons from randomized controlled trials.","authors":"Xin Dai, Yuxi Deng, N Sabrina Idrose, Shyamali C Dharmage, Caroline J Lodge","doi":"10.1080/17476348.2026.2735502","DOIUrl":"https://doi.org/10.1080/17476348.2026.2735502","url":null,"abstract":"<p><strong>Introduction: </strong>People with asthma and chronic obstructive pulmonary disease (COPD) may experience worsening respiratory symptoms during high pollution events. High-Efficiency Particulate Air (HEPA) filtration removes fine particles and may reduce indoor exposure and respiratory morbidity.</p><p><strong>Areas covered: </strong>We narratively synthesized randomized controlled trials (RCTs) of portable HEPA filtration in asthma and COPD. PubMed and Scopus were searched from inception to 5 May 2026, reference lists were updated on 10 June 2026. Trials consistently demonstrated substantial reductions in indoor PM<sub>2.5</sub>, but clinical effects were heterogeneous: several asthma trials reported improvements in symptoms, peak flow and/or quality of life, particularly in highly symptomatic or higher‑exposure subgroups, whereas most spirometric endpoints showed small or no change. Evidence for benefit in people with COPD was limited but promising. Key methodological limitations across trials included short follow‑up periods, lack of adult studies, information on device specifications, adherence measurements, economic evaluations, and under‑representation of low‑resource settings.</p><p><strong>Expert opinion: </strong>HEPA filtration warrants further evaluation in adequately powered, pragmatic RCTs with standardized device specification reporting, longer follow‑up, adherence support, prespecified primary outcomes and cost‑effectiveness analyses. Trials should include diverse populations and assess high‑exposure periods, and public clean‑air shelters to inform equitable policy for protecting vulnerable populations.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-15"},"PeriodicalIF":2.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013406","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":"Post-influenza syndromes: a hidden burden in clinical practice.","authors":"Sotirios Tsiodras","doi":"10.1080/17476348.2026.2736888","DOIUrl":"10.1080/17476348.2026.2736888","url":null,"abstract":"<p><strong>Introduction: </strong>Influenza is still taught and managed as a self-limited acute respiratory illness. The COVID-19 pandemic forced a reexamination of every respiratory virus and made a longer time horizon impossible to ignore. Comparator-controlled cohort data now indicate that influenza, like SARS-CoV-2, is followed by persistent, new-onset multi-system disease that is largely invisible in practice.</p><p><strong>Areas covered: </strong>This perspective reframes influenza as a systemic infection with a distinct post-acute footprint. Drawing on autopsy, experimental and comparative-cohort evidence, a working construct of post-acute influenza syndrome (PAIS) is outlined across its cardiovascular, pulmonary, infectious, neurological, metabolic, renal and immunological components. Literature was identified through PubMed searches combining post-acute, post-influenza and post-viral terms with influenza (run to June 2026), with citation tracking, prioritizing studies with a non-influenza comparator. Influenza is framed as a cardiovascular stress test and a trigger of long-term multimorbidity in the already vulnerable, alongside the unresolved conflict over whether its cardiac burden exceeds that of COVID-19.</p><p><strong>Expert opinion: </strong>Post-influenza sequelae are real, clinically consequential, and systematically missed because of delayed onset, attribution bias and fragmented care. Vaccination, longitudinal follow-up of high-risk survivors and integrated care pathways should become standard practice within five years.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-15"},"PeriodicalIF":2.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992908","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}
Anne Sibille, Jessica Hendrick, Aurore Cue Alvarez, Marie Ernst, Laurence Seidel, Bernard Duysinx, Renaud Louis, Jean-Louis Corhay
{"title":"Environmental and occupational exposure in newly diagnosed lung cancer - data from the PROTEON study.","authors":"Anne Sibille, Jessica Hendrick, Aurore Cue Alvarez, Marie Ernst, Laurence Seidel, Bernard Duysinx, Renaud Louis, Jean-Louis Corhay","doi":"10.1080/17476348.2026.2729508","DOIUrl":"10.1080/17476348.2026.2729508","url":null,"abstract":"<p><strong>Background: </strong>Environmental (E) and occupational (O) lung cancer (LC) is under-reported. Raising the awareness for this problem could help optimize prevention and screening.</p><p><strong>Methods: </strong>In 181 consecutive non-small cell LC patients (January 2023-December 2024, University Hospital of Liège, Belgium) E risk factors (RF) and ORF were collected through a self-reporting questionnaire (open and direct questions) with sociodemographic, tumor- and work-related data. The primary objective was to identify ERF and ORF prevalence.</p><p><strong>Results: </strong>Mean age was 68.2 ± 8.8 years, 55.8% males, 93.4% (former) smokers. Half of the patients (53%) lived in (peri-)urban areas. 50% disclosed an obstructive airway disease and 31.5% had a positive LC family history. Of the 270 jobs registered, 78.5% were manual. Only 23.8% of the workers used protective equipment. 72.4% of the patients reported exposure to at least one ORF through direct questions, and the most frequent pulmonary carcinogens were asbestos (36.5%), silica (22.1%), welding fumes (15.5%), polycyclic aromatic hydrocarbons (14.9%), and diesel engine exhaust (14.4%). Overall, 93.9% of patients reported at least one E/ORF other than tobacco. A request for compensation was introduced in <3% of the patients.</p><p><strong>Conclusion: </strong>Non-tobacco RF for LC are virtually always present in non-small cell LC patients and under-reported.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT00005602,259).</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908167","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}
Margarethe Wiedenmann, Ziyaad Dangor, Shabir A Madhi
{"title":"Clesrovimab, a monoclonal antibody for the prevention of respiratory syncytial virus disease in infants: a drug profile.","authors":"Margarethe Wiedenmann, Ziyaad Dangor, Shabir A Madhi","doi":"10.1080/17476348.2026.2729505","DOIUrl":"10.1080/17476348.2026.2729505","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection (LRTI) in young children. In children <5 years old, it causes an estimated 33 million LRTI episodes and over 100,000 deaths annually, two-thirds of which occur in infants. The licensure of new long-acting monoclonal antibodies and a maternal RSV vaccine offer opportunities for reducing RSV related infant morbidity and mortality.</p><p><strong>Areas covered: </strong>This drug profile reviews clesrovimab (Enflonsia, Merck & Co. Inc. Rahway, NJ U.S.A.), an extended half-life human IgG1κ monoclonal antibody, targeting the highly conserved antigenic site IV of the RSV fusion protein. We synthesize evidence from phase 1 to phase 3 clinical trials, pharmacokinetic and pharmacodynamic data, regulatory approvals and resistance profiling, drawing on peer-reviewed literature and regulatory sources available until May 2026.</p><p><strong>Expert opinion: </strong>Clesrovimab offers a single, fixed-dose, weight-independent injection per RSV season, with demonstrated safety and efficacy against medically attended RSV disease and hospitalization in infants. Its epitope target is distinct from that of nirsevimab (site Ø) and no cross resistance between the two antibodies has been observed <i>in vitro</i>. Equitable global access to monoclonal antibodies, particularly for low- and middle-income countries, remains critical to reduce the global RSV burden.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889925","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 lobe predominance of fibrocavitary mycobacterial lung disease: physiological, biochemical, and biomechanical mechanisms.","authors":"Edward D Chan, Béla Suki","doi":"10.1080/17476348.2026.2727166","DOIUrl":"10.1080/17476348.2026.2727166","url":null,"abstract":"","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-5"},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883036","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 effect of flooding on respiratory health in children and adults.","authors":"Erol A Gaillard","doi":"10.1080/17476348.2026.2726581","DOIUrl":"10.1080/17476348.2026.2726581","url":null,"abstract":"<p><strong>Introduction: </strong>The occurrence of severe storms and floods has steadily increased over the last decades world-wide because of climate change and global warming. Flooding events have important effects on respiratory health especially in vulnerable populations. Some health effects are immediate, such as respiratory infections, asthma attacks and chronic obstructive pulmonary disease exacerbations. An important immediate risk arises for patients with technology dependent respiratory conditions if power supplies fail. Post-flood, indoor damp and mold develop in flooded homes creating a high risk of developing chronic respiratory disease in residents.</p><p><strong>Areas covered: </strong>This review summarizes what is known about the immediate and the medium- to long-term effects of flooding on respiratory health. The negative health effects of prolonged living in a damp and moldy home are discussed.</p><p><strong>Expert opinion: </strong>Climate change and global warming appear to be progressing at a more rapid pace than previously predicted and this will increase the number and the severity of global storm and flood events. Floods pose a substantial risk to patients with chronic respiratory disease and health systems world-wide need to be more aware and prepare to manage the immediate and the long-term needs of increasing numbers of patients affected by natural disasters.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868582","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":"Effects of physical rehabilitation interventions on pulmonary hypertension: an overview of systematic reviews of randomized controlled trials.","authors":"Natália Lopes Cardoso, Ilsa Priscila Santos, Luciana Mendes, Rodrigo Torres-Castro, Jordi Vilaró, Elena Gimeno-Santos, Isabel Blanco, Guilherme Fregonezi, Vanessa Resqueti","doi":"10.1080/17476348.2026.2675630","DOIUrl":"10.1080/17476348.2026.2675630","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary hypertension (PH) is characterized by exertional dyspnea and reduced exercise capacity. This study aims to synthesize current evidence to guide more effective exercise-based interventions.</p><p><strong>Methods: </strong>This overview included systematic reviews (SRs) of randomized controlled trials in adults with PH that performed an exercise intervention as exercise training (ET), inspiratory muscle training (IMT) or combined training (CT). The main outcome was exercise capacity measured (e.g. six-minute walk test (6MWT) or cardiopulmonary exercise test (CPET). The searches were conducted in seven databases. Two independent reviewers conducted the analysis, with a third resolving disagreements. Methodological quality and certainty of evidence were assessed using AMSTAR-2 and GRADE, along with overlap analysis.</p><p><strong>Results: </strong>A total of 14 SRs were included, categorized into ET, IMT, and CT. All three interventions demonstrated improvements in functional capacity, with increases in 6MWT distance of >48.5 m (ET), 39.1 m (IMT), and 49.5 m (CT). VO<sub>2</sub>peak improved in ET and CT groups by >2.07 and >3.0 mL/kg/min, respectively. Only one study performed IMT, with gains. Overall, methodological quality was rated as critically low, with significant overlap across studies.</p><p><strong>Conclusion: </strong>These findings suggest a clinically significant benefit of exercise-based interventions, with a slight superiority of CT.<b>Protocol registration:</b> http://www.crd.york.ac.uk/prospero identifier is CRD42025643615.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1097-1107"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950438","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}
Lucia Allavena, Jessica Mencarini, Giovanni Fumagalli, Antonio Di Biagio, Silvia Nozza, Andrea Calcagno, Maurizio Ferrarese, Marialuisa Valente, Stefania Cerri, Filippo Bartalesi, Luigi Ruffo Codecasa, Niccolò Riccardi
{"title":"Individualized TB care for drug-susceptible pulmonary tuberculosis: clinical alternatives when HRZE is contraindicated or not tolerated.","authors":"Lucia Allavena, Jessica Mencarini, Giovanni Fumagalli, Antonio Di Biagio, Silvia Nozza, Andrea Calcagno, Maurizio Ferrarese, Marialuisa Valente, Stefania Cerri, Filippo Bartalesi, Luigi Ruffo Codecasa, Niccolò Riccardi","doi":"10.1080/17476348.2026.2682314","DOIUrl":"10.1080/17476348.2026.2682314","url":null,"abstract":"<p><strong>Introduction: </strong>While the standard HRZE regimen is the cornerstone of drug-susceptible tuberculosis (DS-TB) treatment, its success is frequently undermined by treatment-limiting adverse drug reactions (ADRs) and complex drug-drug interactions (DDIs). In clinical practice, managing those situations remains a critical challenge often overlooked by guidelines. Effective toxicity management is essential to prevent treatment interruption, loss-to-follow up, relapse, and escalating healthcare costs.</p><p><strong>Areas covered: </strong>We provided a clinical framework for identifying and mitigating toxicities associated with HRZE regimen. Reviewing current literature and international guidelines, we analyzed different ADRs, provided safety profiles and management strategies for each HRZE drug. The discussion includes structured protocols for sequential drug re-challenge, management of high-risk populations, and DDIs. Furthermore, we evaluate evidence-based alternative regimens for cases where the standard of care is untenable.</p><p><strong>Expert opinion: </strong>DS-TB therapy must evolve from rigid protocols toward a precision medicine framework prioritizing patient safety alongside efficacy. We advocate for a 'shorter is better, less is more' approach, emphasizing regimen simplification and better-tolerated agents. Clinical success often depends on proactive communication between clinicians and patients, as well as individualized therapeutic adjustments, rather than on novel compounds alone. Bridging the gap between standardized guidelines and nuanced clinical judgment is vital for optimizing real-world outcomes.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1045-1054"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059000","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}
Lohuwa Mamudu, Yazmin Acosta, Erasmus Tetteh-Bator, Danny H Kim, Phillip Gedalanga, Bo Young Park, Mubarak Osman, Sampson E Akwafuo, Mohammad Masum, Paul H Atandoh
{"title":"Racial/ethnic disparities in environmental respiratory allergies among cancer patients: national health interview survey analysis.","authors":"Lohuwa Mamudu, Yazmin Acosta, Erasmus Tetteh-Bator, Danny H Kim, Phillip Gedalanga, Bo Young Park, Mubarak Osman, Sampson E Akwafuo, Mohammad Masum, Paul H Atandoh","doi":"10.1080/17476348.2026.2670015","DOIUrl":"10.1080/17476348.2026.2670015","url":null,"abstract":"<p><strong>Background: </strong>Environmental respiratory allergies (ERA) can worsen the quality of life of cancer patients. This study examined the prevalence, association, and racial/ethnic disparities in ERA diagnosis among cancer patients in the United States.</p><p><strong>Methods: </strong>We analyzed a retrospective cross-sectional dataset from the National Health Interview Survey (2021) involving weighted samples of 1,879 U.S. adults aged ≥18 years. Bivariate and multivariable analyses were conducted, adjusting for covariates.</p><p><strong>Results: </strong>The prevalence rate of ERA among cancer patients was 55.5%, with a significant difference among race/ethnicity. Non-Hispanic other/Multiracial had the highest prevalence of ERA (83.1%), followed by non-Hispanic Asians (68.2%), and non-Hispanic Black/African American (65.2%). Non-Hispanic Other/Multiracial cancer patients had significantly higher odds of ERA compared to non-Hispanic Whites in sociodemographic, socioeconomic, and fully adjusted models, respectively. Similarly, Non-Hispanic Blacks/African Americans had increased odds of ERA compared to non-Hispanic Whites (AOR = 1.58, 95% CI = 1.00-2.56) after adjusting for education and health insurance. Additionally, race/ethnic minority cancer patients were 1.22 times more likely to be at risk of ERA than their non-Hispanic White counterparts.</p><p><strong>Conclusion: </strong>This study demonstrates that racial/ethnic disparities exist in ERA diagnosis among cancer patients. Therefore, targeted interventions aimed at addressing these disparities can help improve the quality of life for cancer patients.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"1109-1117"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825049","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}