Expert review of respiratory medicine最新文献

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Pathological roles of transient receptor potential channels in chronic obstructive pulmonary disease: special focus on cellular mechanisms. 瞬时受体电位通道在慢性阻塞性肺疾病中的病理作用:特别关注细胞机制。
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-08-01 Epub Date: 2026-03-30 DOI: 10.1080/17476348.2026.2652117
Yi-Ran Ye, Yu-Yun Zhou, Su Qu, Wen-Liang Zhou, Lei Chen, Yi-Lin Zhang
{"title":"Pathological roles of transient receptor potential channels in chronic obstructive pulmonary disease: special focus on cellular mechanisms.","authors":"Yi-Ran Ye, Yu-Yun Zhou, Su Qu, Wen-Liang Zhou, Lei Chen, Yi-Lin Zhang","doi":"10.1080/17476348.2026.2652117","DOIUrl":"10.1080/17476348.2026.2652117","url":null,"abstract":"<p><strong>Introduction: </strong>Transient receptor potential (TRP) channels comprise a superfamily of cation-permeable channels broadly expressed in the respiratory tract, playing essential roles in regulating epithelial integrity, mucus secretion, mechanotransduction, and innate immune responses. Increasing evidence suggests that dysregulation of TRP channels contributes to the pathogenesis of chronic obstructive pulmonary disease (COPD).</p><p><strong>Areas covered: </strong>This review summarizes current insights into the cellular mechanisms by which TRP channels contribute to COPD, with particular emphasis on respiratory epithelial dysfunction while also incorporating selected non-epithelial mechanisms relevant to disease pathogenesis. A comprehensive literature search was conducted in PubMed and Web of Science up to January 2026.</p><p><strong>Expert opinion: </strong>Evidence for TRP involvement in COPD is heterogeneous. TRPV4 currently has the strongest mechanistic and translational support, whereas TRPC1 and TRPC6 still require further therapeutic validation. TRPV2 appears to be linked more specifically to macrophage dysfunction and emphysema-related pathology, whereas the roles of TRPV6 and TRPM6 are still incompletely defined. A key barrier to clinical translation is that numerous TRP-targeted strategies have been developed outside COPD or have shown limited efficacy in the clinical settings tested to date, while safety concerns also remain. Future progress will require COPD-specific validation, localized delivery, and biomarker-guided treatment strategies matched to defined disease phenotypes.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"953-962"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147523248","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}
引用次数: 0
From ideal respiratory health to chronic lung disease: indicators of impaired respiratory health. 从理想的呼吸系统健康到慢性肺病:呼吸系统健康受损的指标。
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-08-01 Epub Date: 2026-03-03 DOI: 10.1080/17476348.2026.2637202
Kavitha C Selvan, Joseph I Bailey, Ravi Kalhan
{"title":"From ideal respiratory health to chronic lung disease: indicators of impaired respiratory health.","authors":"Kavitha C Selvan, Joseph I Bailey, Ravi Kalhan","doi":"10.1080/17476348.2026.2637202","DOIUrl":"10.1080/17476348.2026.2637202","url":null,"abstract":"<p><strong>Introduction: </strong>Ideal respiratory health and chronic respiratory disease exist on a continuum. Between these two extremes lies an intermediate state of impaired respiratory health, characterized by clinical phenotypes that exist along the causal pathway. Identifying individuals with intermediate phenotypes of impaired respiratory health offers an opportunity to intercept progression to chronic respiratory disease.</p><p><strong>Areas covered: </strong>In this review, we identify parameters associated with impaired respiratory health, including respiratory symptoms and illnesses, abnormal lung physiology, imaging abnormalities, and blood biomarkers. We then synthesize evidence linking these parameters to future respiratory impairment.</p><p><strong>Expert opinion: </strong>Drawing inspiration from advances in cardiovascular disease prevention, the respiratory field must adopt a holistic framework that considers the likely shared biologic mechanisms underpinning chronic lung diseases. Effective disease prevention depends on a multi-omic approach that integrates clinical, physiologic, imaging, and molecular data to identify individuals at increased risk for chronic respiratory disease. Prospective evaluation of these at-risk individuals can be utilized to evaluate the impact of targeted preventative strategies.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"901-912"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313633","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
Airway clearance techniques - a proposed classification based on definitions? 气道清除技术-基于定义的拟议分类?
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-02-17 DOI: 10.1080/17476348.2026.2626079
Gregory Reychler, Nicolas Audag, Guillaume Prieur, William Poncin, Olivier Contal
{"title":"Airway clearance techniques - a proposed classification based on definitions?","authors":"Gregory Reychler, Nicolas Audag, Guillaume Prieur, William Poncin, Olivier Contal","doi":"10.1080/17476348.2026.2626079","DOIUrl":"10.1080/17476348.2026.2626079","url":null,"abstract":"<p><strong>Introduction: </strong>Airway clearance techniques (ACT) are a longstanding modality of treatment in many chronic respiratory diseases. Their aims are to counteract airway obstruction by mobilizing airway secretions and/or by limiting the airway collapse.</p><p><strong>Areas covered: </strong>This review first outlines the physiological mechanisms underlying ACT. In a second part, it categorizes the ACT into seven distinct groups. These groups include both instrumental and non-instrumental ACT. Strategies such as physical activity and upper airway clearance techniques are also considered as ACT due to their complementary roles in mobilizing airway secretions.</p><p><strong>Expert opinion: </strong>The lack of standardized definitions for airway clearance techniques (ACT) leads to significant differences in the clinical practice and effects because the variability in physiological mechanisms. Studies show that both manual and instrumental ACT are influenced by therapist-dependent factors such as applied force, duration of the application, and patient positioning. To ensure reproducibility and effective teaching, a single, physiologically grounded description of ACT is urgently needed.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"811-827"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146128081","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}
引用次数: 0
Biomarkers for the diagnosis and phenotyping of acute chest syndrome in patients with sickle cell disease. 镰状细胞病患者急性胸综合征诊断和表型的生物标志物
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-01-28 DOI: 10.1080/17476348.2026.2622719
Maria Srour, Dylan Landis, Jenny Kim, Molly Montgomery, Roberto Machado
{"title":"Biomarkers for the diagnosis and phenotyping of acute chest syndrome in patients with sickle cell disease.","authors":"Maria Srour, Dylan Landis, Jenny Kim, Molly Montgomery, Roberto Machado","doi":"10.1080/17476348.2026.2622719","DOIUrl":"10.1080/17476348.2026.2622719","url":null,"abstract":"<p><strong>Introduction: </strong>Acute Chest Syndrome (ACS) is a serious and often fatal complication of Sickle Cell Disease (SCD). In the absence of specific biomarkers that indicate the development of ACS, diagnosis can be nebulous and difficult. In this narrative literature review, we examine the current evidence for novel biomarkers associated with acute and long-term propensity toward ACS.</p><p><strong>Areas covered: </strong>A search focused on terms related to 'acute chest syndrome,' 'sickle cell anemia,' and 'biomarkers' was created and run by a medical librarian in MEDLINE (Ovid), Google Scholar, and Embase (Ovid). Four-hundred seven articles were found in the initial search. After duplicates removed and irrelevant studies excluded, 13 were included for final data extraction. Data extraction was completed by three authors and collated to form the final manuscript.</p><p><strong>Expert opinion: </strong>Currently, ACS diagnosis remains a great challenge. The reviewed literature shows promise in both novel biomarkers like sputum IL-6 and alternative interpretations of routine studies including blood counts and inflammatory markers. Still, large, multicenter trials to validate reliable and specific markers for ACS remain elusive. Isolating a dependable, rapid, and widely available and affordable biomarker for ACS may help diagnose and change morbidity and mortality from one of SCD's most fatal complications.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"801-810"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041921","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
Glucocorticoid-induced muscle weakness in ECOPD: a perspective on mechanisms and emerging pharmacological interventions. 糖皮质激素诱导的ECOPD肌肉无力:机制和新兴药物干预的观点。
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-01-21 DOI: 10.1080/17476348.2026.2620144
Sandra J van Krimpen, Sami O Simons, Annemie M W J Schols, Ramon C J Langen, Harry R Gosker
{"title":"Glucocorticoid-induced muscle weakness in ECOPD: a perspective on mechanisms and emerging pharmacological interventions.","authors":"Sandra J van Krimpen, Sami O Simons, Annemie M W J Schols, Ramon C J Langen, Harry R Gosker","doi":"10.1080/17476348.2026.2620144","DOIUrl":"10.1080/17476348.2026.2620144","url":null,"abstract":"<p><strong>Introduction: </strong>Muscle weakness represents a significant clinical problem in chronic obstructive pulmonary disease (COPD). During exacerbations of COPD (ECOPD), inflammation, oxidative stress, malnutrition, disuse, hypoxia, and glucocorticoid (GC) levels increase and converge, further aggravating skeletal muscle impairment with GC signaling as a common denominator. No intervention currently exists that specifically prevents or counteracts GC-induced muscle weakness during ECOPD.</p><p><strong>Areas covered: </strong>This review summarizes clinical and pre-clinical evidence on the role of GC signaling in muscle dysfunction during ECOPD. We discuss the underlying molecular mechanisms by which GCs drive muscle weakness, and critically evaluate emerging pharmacological strategies aimed at mitigating these effects. PubMed and Scopus were searched for peer-reviewed papers published before April 2025.</p><p><strong>Expert opinion: </strong>GC-induced muscle weakness is an under-recognized but potentially modifiable contributor to muscle weakness in ECOPD. Particular promise lies in pharmacological interventions such as myostatin pathway inhibitors, selective androgen receptor modulators, and those inducing IGF-1-related protein synthesis. Dedicated translational and clinical research is urgently needed to evaluate these novel interventions in the setting of ECOPD. Effective countermeasures could preserve muscle mass and function, improve exercise capacity and recovery, shorten hospital stay, and lower the risk of recurrence, offering a new therapeutic opportunity in ECOPD management.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"859-871"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014078","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}
引用次数: 0
Impact of anxiety, depression, fatigue, and social isolation in patients with bronchiectasis. 焦虑、抑郁、疲劳和社会隔离对支气管扩张患者的影响
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-02-05 DOI: 10.1080/17476348.2026.2624864
Abebaw Mengistu Yohannes, Pooja Arora, George Marty Solomon
{"title":"Impact of anxiety, depression, fatigue, and social isolation in patients with bronchiectasis.","authors":"Abebaw Mengistu Yohannes, Pooja Arora, George Marty Solomon","doi":"10.1080/17476348.2026.2624864","DOIUrl":"10.1080/17476348.2026.2624864","url":null,"abstract":"","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"765-768"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069378","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}
引用次数: 0
An overview of central sleep apnea with heart failure. 中枢性睡眠呼吸暂停伴心力衰竭的综述。
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-02-02 DOI: 10.1080/17476348.2026.2623999
Aymen Jmai, Sandhya Matthes, Winfried Randerath
{"title":"An overview of central sleep apnea with heart failure.","authors":"Aymen Jmai, Sandhya Matthes, Winfried Randerath","doi":"10.1080/17476348.2026.2623999","DOIUrl":"10.1080/17476348.2026.2623999","url":null,"abstract":"<p><strong>Introduction: </strong>Central sleep apnea (CSA) affects up to one-third of patients with heart failure (HF) and is linked to sympathetic activation, arrhythmias, impaired quality of life, and worse prognosis. Understanding epidemiology, mechanisms, and evolving therapies is essential as management recommendations are rapidly changing.</p><p><strong>Areas covered: </strong>This review synthesizes data retrieved from a PubMed database search on CSA prevalence across HF phenotypes, delineates pathophysiology, and appraises therapies. We performed a structured search for randomized trials, large observational studies, meta-analyses, and recent guidance, with focused appraisal of the latest statements from the American Academy of Sleep Medicine (AASM) and the European Respiratory Society (ERS).</p><p><strong>Expert opinion: </strong>The field is shifting from one size fits all apnea-hyponea index (AHI) suppression to phenotype-guided care, prioritizing patient centered and cardiac outcomes. Integrating endotyping, remote monitoring, and HF co-management is key. Major gaps include optimal patient selection, long-term cardiovascular endpoints, and harmonization of guideline recommendations. If optimization of HF therapy and a continuous positive airway pressure (CPAP) trial fail to improve symptoms, adaptive servoventilation (ASV) becomes the preferred therapeutical option.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"829-846"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088681","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}
引用次数: 0
When cancer treatment affects the lungs: a clinical overview on pulmonary toxicity induced by new cancer drugs. 当癌症治疗影响到肺部:新的抗癌药物引起的肺毒性的临床综述。
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-02-20 DOI: 10.1080/17476348.2026.2631816
Dimitrios Komninos, Emmanouil Psarros, Eva Theochari, George Tsirikos, Fotios Sampsonas, Argyrios Tzouvelekis
{"title":"When cancer treatment affects the lungs: a clinical overview on pulmonary toxicity induced by new cancer drugs.","authors":"Dimitrios Komninos, Emmanouil Psarros, Eva Theochari, George Tsirikos, Fotios Sampsonas, Argyrios Tzouvelekis","doi":"10.1080/17476348.2026.2631816","DOIUrl":"10.1080/17476348.2026.2631816","url":null,"abstract":"<p><strong>Introduction: </strong>Novel targeted therapies and immune checkpoint inhibitors have transformed the therapeutic landscape of lung cancer, significantly improving survival outcomes. However, these new therapeutic agents are accompanied by a broad spectrum of adverse events. Pulmonary adverse events, particularly pneumonitis, represent a clinically significant concern due to their potential severity and impact on treatment continuation.</p><p><strong>Areas covered: </strong>This review summarizes current evidence on pulmonary toxicity associated with tyrosine kinase Inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), with a primary focus on lung cancer. A comprehensive literature search of PubMed and recent clinical trial data was undertaken to investigate the overall incidence and management strategies for pneumonitis and related pulmonary events linked to these therapies. While TKIs and ICIs have revolutionized cancer therapy, pulmonary toxicities, though uncommon, can be life threatening.</p><p><strong>Expert opinion: </strong>Improved understanding of underlying mechanisms, enhanced pharmacovigilance and thorough assessment of risk factors prior to drug- administration are essential to mitigate risks. Clinicians should maintain a high index of suspicion for pneumonitis in patients receiving ICIs or TKIs, and suspected cases should be promptly referred to specialized centers with expertise in therapy-related pulmonary complications.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"887-900"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230377","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}
引用次数: 0
An overview of the importance of allied healthcare for patients with COPD. 慢性阻塞性肺病患者联合医疗保健重要性概述
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-02-10 DOI: 10.1080/17476348.2026.2629007
Sarah Houben-Wilke, Anouk W Vaes, Mara Cuijpers, Gwen Diederen, Sandra Evertse, Jérôme Jansen, Kristel Loven, Paula van Melick, Roy Meys, Rein Posthuma, Maurice J Sillen, Stephanie Ubachs-van Zandvoort, Frits Franssen, Alex van 't Hul, Martijn A Spruit
{"title":"An overview of the importance of allied healthcare for patients with COPD.","authors":"Sarah Houben-Wilke, Anouk W Vaes, Mara Cuijpers, Gwen Diederen, Sandra Evertse, Jérôme Jansen, Kristel Loven, Paula van Melick, Roy Meys, Rein Posthuma, Maurice J Sillen, Stephanie Ubachs-van Zandvoort, Frits Franssen, Alex van 't Hul, Martijn A Spruit","doi":"10.1080/17476348.2026.2629007","DOIUrl":"10.1080/17476348.2026.2629007","url":null,"abstract":"<p><strong>Introduction: </strong>Despite optimal pharmacological treatment, patients with COPD often experience symptoms and report physical, mental, and/or social limitations. This underlines the need for additional, non-pharmacological interventions, such as physical therapy, psychological support, nutritional counseling, and occupational therapy. In this, allied healthcare professionals (AHPs) play a vital role as they bring specialized knowledge and skills to assess and, if needed, treat different aspects of the disease.</p><p><strong>Areas covered: </strong>A broad literature search was conducted to narratively summarize current evidence of allied healthcare, underline the importance of interprofessional collaboration, including the role of patients, and highlight future perspectives.</p><p><strong>Expert opinion: </strong>The evidence of the important role of AHPs in the assessment and treatment of COPD is robust. Unfortunately, allied healthcare is markedly underutilized in patients with COPD. Increasing referral rates to AHPs is essential to optimize COPD management. Collaboration, including the role of the patient, is essential to ensure comprehensive and holistic care, improve outcomes, and enhance communication. In the future, AHPs will be challenged to dare to think beyond their own expertise and expand their scope.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"873-885"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145312","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}
引用次数: 0
The double threat: bacterial and fungal co-/superinfection in viral pneumonia. 双重威胁:病毒性肺炎中的细菌和真菌共感染/重复感染。
IF 2.7
Expert review of respiratory medicine Pub Date : 2026-07-01 Epub Date: 2026-02-10 DOI: 10.1080/17476348.2026.2629003
Arsah Asis, Alejandro Rodríguez, Luis Felipe Reyes, Emili Díaz, Saad Nseir, Ignacio Martín-Loeches
{"title":"The double threat: bacterial and fungal co-/superinfection in viral pneumonia.","authors":"Arsah Asis, Alejandro Rodríguez, Luis Felipe Reyes, Emili Díaz, Saad Nseir, Ignacio Martín-Loeches","doi":"10.1080/17476348.2026.2629003","DOIUrl":"10.1080/17476348.2026.2629003","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory viral pneumonias are a leading cause of severe respiratory failure and intensive care unit (ICU) admission worldwide. Although viral infection itself drives significant morbidity and mortality, secondary bacterial and fungal superinfections represent a critical 'double threat' in critically ill adults, exacerbating lung injury, prolonging organ dysfunction, and complicating antimicrobial management. Experience from the Influenza A (H1N1) pdm09 and SARS-CoV-2 pandemics highlights a persistent mismatch between low documented bacterial co-infection rates and widespread empiric antibiotic exposure, underscoring diagnostic uncertainty and antimicrobial stewardship challenges in the ICU.</p><p><strong>Areas covered: </strong>This review examines the epidemiology, immunopathogenesis, and diagnostic approaches to bacterial and fungal superinfection in adult ICU patients with severe viral pneumonia. Evidence is synthesized from large ICU cohorts, pandemic data, and established consensus definitions for influenza- and COVID-19-associated pulmonary aspergillosis (IAPA, CAPA). The review discusses advances in molecular diagnostics, lower respiratory tract sampling, bronchoalveolar lavage - based mycology, and biomarker-guided strategies, with a focused literature search of ICU-specific studies.</p><p><strong>Expert opinion: </strong>Bacterial and fungal superinfections, while infrequent, carry substantial clinical impact in severe viral pneumonia. A multimodal, ICU-adapted diagnostic strategy integrating pathogen detection with host-response assessment is essential to support timely therapy, enable antimicrobial de-escalation, and align superinfection management with stewardship principles.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":" ","pages":"847-858"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133749","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}
引用次数: 0
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