Impact of obesity on pulmonary function: current understanding and knowledge gaps
Purpose of review Obesity is an increasing world-wide public health concern. Obesity both causes respiratory symptoms and contributes to many cardiorespiratory diseases. The effects of obesity on commonly used lung function tests are reviewed. Recent findings The effects of obesity on lung function are attributed both to mechanical factors and to complex metabolic effects that contribute to a pro-inflammatory state. The effects of obesity on lung function correlate with BMI and correlate even better when the distribution of excess adipose tissue is taken into account, with central obesity associated with more pr...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Beta-blockers in chronic obstructive pulmonary disease: the good, the bad and the ugly
Purpose of review Several observational studies have suggested that β-blockers, especially cardioselective ones, are well tolerated and associated with a lower risk of acute exacerbations and death in patients with chronic obstructive pulmonary disease (COPD). However, there are dissenting studies. This review provides an update on the use of β-blockers in COPD, focusing on results of recent prospective studies and randomized controlled trials. Recent findings In totality, cohort studies indicate that β-blockers are generally well tolerated and effective in COPD patients who also have a clear card...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

How might endotyping guide chronic obstructive pulmonary disease treatment? Current understanding, knowledge gaps and future research needs
Purpose of review This review discusses emerging therapies directed at chronic obstructive pulmonary disease (COPD) endotypes and pathobiological processes that manifest as the disease. Recent findings Specific endotypes have been targeted in COPD. These include eosinophilic inflammation, overproduction of interleukin-17, chronic bronchitis and altered nature of mucous, and chronic infection. Therapies exactly directed at the cause of these endotypes or their resultant clinical findings have been assessed. Although some intermediate outcomes have seemed promising, there have been no findings that shift the parad...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Diagnostic and therapeutic challenges of chronic obstructive pulmonary disease in the elderly
Purpose of review Chronic obstructive pulmonary disease (COPD) imposes a large burden on the global population and even more so for the elderly who face significant obstacles in the diagnosis, management, and psychosocial effects of the disease. This review describes the current challenges and key points in the management of COPD in the elderly. Recent findings Lower limit rather than fixed cut off of the FEV1/FVC ratio can improve the diagnosis and better predict COPD mortality. High relative to standard dose influenza vaccination reduces confirmed cases of influenza overall and reduces hospitalizations in olde...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Obstructive lung diseases and allergic bronchopulmonary aspergillosis
Purpose of review Allergic bronchopulmonary aspergillosis (ABPA) is a disease frequently complicating asthma and cystic fibrosis. ABPA is increasingly recognized in other obstructive lung diseases (OLDs), including chronic obstructive pulmonary disease (COPD) and noncystic fibrosis bronchiectasis. Herein, we summarize the recent developments in ABPA complicating OLDs. Recent findings Recent research has described the clinical features and natural history of ABPA complicating asthma in children and the elderly. We have gained insights into the pathophysiology of ABPA, especially the role of eosinophil extracellul...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

An update on hypersensitivity pneumonitis: what a clinician wants to know
Purpose of review A recent international collaboration has updated the clinical definition and diagnostic recommendations for hypersensitivity pneumonitis, focusing on fibrotic and non-fibrotic phenotypes. However, how these transfer to clinical practice and their impact upon clinical management and prognosis of hypersensitivity pneumonitis is unclear. This review will focus on recent advances in the understanding of the clinical aspects of hypersensitivity pneumonitis, predominantly its epidemiology, diagnosis, classification and treatment. Recent findings Hypersensitivity pneumonitis is a rare disease within t...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Vaping epidemic in US teens: problem and solutions
This article summarizes key research findings that explain the reasons for the epidemic, health consequences of vaping, and provides an overview of efforts to mitigate the vaping threat to US teens. (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

COVID-19: a new burden of respiratory disease among South African miners?
Purpose of review Mineworkers in South Africa experience a triple burden of disease due to their distinct work experience. Silicosis increases their risk of tuberculosis (TB), exacerbated by the HIV epidemic. Work-related factors are likely to increase transmission, severity, and post infection sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Understanding these relationships is important to control the impact of the epidemic. Recent findings SARS-CoV-2 infection rates among mineworkers exceed the population rates in the provinces in which those mines are located. Migrant work,...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

ICU preparedness in pandemics: lessons learned from the coronavirus disease-2019 outbreak
Purpose of review The worldwide SARS-CoV-2 pandemic has taken a heavy toll on ICUs worldwide. This review expounds on lessons learned for ICU preparedness during the pandemic and for future mass casualty events. Recent findings In the 21st century, there have already been several outbreaks of infectious diseases that have led to mass casualties creating ICU strain, providing multiple opportunities for hospitals and hospital systems to prepare their ICUs for future events. Unfortunately, the sheer scale and rapidity of the SARS-CoV-2 pandemic led to overwhelming strain on every aspect of ICU disaster preparedness...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Unprecedented: the toxic synergism of Covid-19 and climate change
Purpose of review To review and compare the constellations of causes and consequences of the two current pandemics, Covid-19 and climate change. Recent findings There has been a transient counterbalancing, in which the response to Covid-19 has briefly mitigated pollution and greenhouse gasses. This divergence belies multiple commonalities of cause and effect. Summary The convergence of these two pandemics is unprecedented. Although at first glance, they appear to be completely unrelated, they share striking commonalities. Both are caused by human behaviors, and some of those behaviors contribute to both p...
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Editorial: Palliative care considerations and ethical issues in the care of Covid-19 patients
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Editorial: A trio of articles on Covid-19, followed by articles on vaping, hypersensitivity pneumonitis, and several on obstructive airway and pulmonary diseases
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2021 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Revisiting matrix metalloproteinase 12: its role in pathophysiology of asthma and related pulmonary diseases
Purpose of review Matrix metalloproteinases (MMPs) are a family of over 20 zinc-dependent proteases with different biological and pathological activities, and many have been implicated in several diseases. Although nonselective MMP inhibitors are known to induce serious side-effects, targeting individual MMPs may offer a safer therapeutic potential for several diseases. Hence, we provide a concise overview on MMP-12, given its association with pulmonary diseases, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, and other progressive pulmonary fibrosis (PPF), which may also ...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Asthma and severe acute respiratory syndrome coronavirus 2019: current evidence and knowledge gaps
Purpose of review Although respiratory viruses are common triggers of asthma exacerbation, it is unknown whether this also applies to infection with SARS-CoV-2. Indeed, patients with asthma and allergy appear underrepresented in large reports of COVID-19 cases worldwide. In this review, we evaluate existing literature on this topic and potential underlying mechanisms for any interrelationship between asthma and COVID-19. Recent findings Data from several preclinical and clinical reports suggest a lower susceptibility for COVID-19 in patients with underlying type 2 airway inflammation including asthma that may be...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Telemedicine and adherence monitoring in children with asthma
Purpose of review Telemedicine, defined as synchronous video visits between a provider and a child with asthma, often takes place in the school setting. This review examines the new electronic sensors for adherence monitoring and studies that used telemedicine in the school setting to improve asthma outcomes. Recent findings School-based telemedicine provides an important service to families of school-aged children who have difficulty due to time and distance in planning and keeping in-person appointments with primary or specialty providers. Significant improvements in objective measures of asthma control are in...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Diabetes, insulin resistance, and asthma: a review of potential links
Purpose of review Disorders of glucose metabolism, including insulin resistance, prediabetes, and diabetes, have been identified as risk factors for worsened asthma. This review summarizes emerging evidence for their role as modifiable risk factors in asthma, including the potential benefit of diabetes medications on asthma outcomes. Recent findings Experimental studies show that hyperinsulinemia associated with insulin resistance is associated with airway smooth muscle proliferation and promotes contractility. Epidemiologic studies have identified a higher prevalence of glycemic dysfunction among those with sev...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Managing chronic rhinosinusitis in severe asthma
Purpose of review Over half of all patients with severe asthma have chronic rhinosinusitis (CRS). Although distinct and specialized in function and form, the upper and lower airways share similar and inter-related pathophysiologic mechanisms. The severity of CRS particularly in patients with nasal polyps can correlate with that of asthma and vice versa. The purpose of this review is to elucidate the relationship between these conditions and summarize key elements in the management of these patients. Recent findings Several advances have been made in the evaluation and treatment of patients with CRS and asthma. F...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Allergen bronchoprovocation test: an important research tool supporting precision medicine
Purpose of review Allergen bronchoprovocation test (ABT) has been used to study asthma pathophysiology and as a disease-modelling tool to assess the properties and efficacy of new asthma drugs. In view of the complexity and heterogeneity of asthma, which has driven the definition of several phenotypes and endotypes, we aim to discuss the role of ABT in the era of precision medicine and provide guidance for clinicians how to interpret and use available data to understand the implications for the benefits of asthma treatment. Recent findings In this review, we summarize background knowledge and applications of ABT...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Novel approaches in occupational asthma diagnosis and management
Purpose of review To describe the recent findings of the last 2 years on the epidemiology and phenotypes of occupational asthma, as well as new developments in its diagnosis and management. Recent findings Data from nine longitudinal studies showed a population attributable fraction for the occupational contribution to incident asthma of 16%. The main phenotypes of occupational asthma are: occupational asthma caused by high-molecular-weight (HMW) or low-molecular-weight (LMW) agents, irritant-induced asthma and occupational asthma-chronic obstructive pulmonary disease overlap. Among the variety of causative agen...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

The impact of fungal allergic sensitization on asthma
Purpose of review Fungal sensitization may contribute to the development of asthma as well as asthma severity. The purpose of this review is to summarize existing knowledge about the pathophysiology, diagnosis, and management of fungal sensitization in asthma and highlight unmet needs and target areas for future investigation. Recent findings Fungal sensitization may occur by a normal or aberrant immune response. Allergic sensitization to fungi is mediated by the adaptive immune response driven by TH2 cells and the innate immune response driven by the innate lymphoid cells group 2. Diagnosis of fungal sensitizat...
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Editorial: Dealing with asthma during the turbulent times of coronavirus disease-2019
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: ASTHMA: Edited by Zuzana Diamant and Nicola A. Hanania Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - December 3, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Changing landscape: psychological care in the era of cystic fibrosis transmembrane conductance regulator modulators
Purpose of review The current review provides an overview of key psychological issues and challenges for the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator era of care. It discusses research from diagnosis and beyond, to patient-team communication with a particular focus on medical trials, adherence and living with CFTR modulators. Recent findings The impact of the diagnosis on parents is immense and the complexity of treatment now and in the future, are a challenge for both parents and teams. Communicating digitally is starting to become daily practice for many in CF care, with coronavirus ...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Sexual and reproductive health in cystic fibrosis
Purpose of review With improving life expectancy and quality of life, sexual and reproductive health (SRH) has become an increasingly important aspect of patient-centered cystic fibrosis care. This review aims to describe advances in cystic fibrosis-related SRH and highlight optimal practices. Recent findings Recent publications suggest that people with cystic fibrosis follow a similar trajectory of sexual development and activity as their noncystic fibrosis peers, although contraception use is lower. Although fertility is reduced in patients with cystic fibrosis, improved survival and assisted reproductive technologi...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Treatment of pulmonary exacerbations in cystic fibrosis
Purpose of review This review will discuss the challenges of defining a pulmonary exacerbations in cystic fibrosis and the key pathogens, which contribute. It will discuss the treatment options currently available and the importance of preventing pulmonary exacerbations. Recent findings The basis for treatment of pulmonary exacerbations remains unchanged over the past 15 years and whilst there have been trials exploring alternative antibiotics, there has been little change. However, there are ongoing studies that are expected to establish a platform for identifying best practices. Chronic cystic fibrosis therapies hav...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Monitoring early stage lung disease in cystic fibrosis
Purpose of review Early stage lung disease has long been synonymous with infancy and childhood. As diagnosis happens earlier and conventional management improves, we are seeing larger proportions of people with cystic fibrosis (CF) in adolescence and even adulthood with well preserved lung health. The availability of highly effective cystic fibrosis transmembrane conductance regulator modulator drugs for a large proportion of the CF population will impact even further. Transitioning into adult care with ‘normal’ lung function will become more common. However, it is crucial that we are not blasé about t...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Editorial: The changing landscape of cystic fibrosis: new therapies, challenges and a global pandemic
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: CYSTIC FIBROSIS: Edited by Peter J. Barry and Barry J. Plant Source Type: research

Obstructive sleep apnea and cancer: a complex relationship
Purpose of review Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA–cancer association. Recent findings According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effect...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Alternative algorithms and devices in sleep apnoea diagnosis: what we know and what we expect
Purpose of review Diagnosis of sleep apnoea was performed in sleep laboratories with polysomnography. This requires a room with supervision and presence of technologists and trained sleep experts. Today, clinical guidelines in most countries recommend home sleep apnoea testing with simple systems using six signals only. If criteria for signal quality, recording conditions, and patient selection are considered, then this is a reliable test with high accuracy. Recent findings Recently diagnostic tools for sleep apnoea diagnosis become even more simple: smartwatches and wearables with smart apps claim to diagnose sleep a...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Does gender matter: sex-specific aspects of symptoms, outcome, and therapy of obstructive sleep apnea
Purpose of review Obstructive sleep apnea (OSA) has historically been considered as a male disease. As a result, female individuals with OSA were often under-diagnosed and under-treated compared with male individuals. However, recent data suggest that several OSA-associated adverse cardiovascular outcomes are more pronounced in women. Recent findings This review provides a summary of the most relevant recent evidence with regard to sex-specific OSA characteristics, including atypical symptoms, greater quality of life impairment and several more pronounced adverse outcomes in female individuals compared with male indiv...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Opioids and sleep
Purpose of review Summarize the effects of opioids on sleep including sleep architecture, sleep disordered breathing (SDB) and restless legs syndrome. Recent findings Opioids are associated with the development of central sleep apnea (CSA) and ataxic breathing. Recent reports suggest that adaptive servo-ventilation may be an effective treatment for CSA associated with opioids. Summary Opioids have multiple effects on sleep, sleep architecture and SDB. Although originally described with methadone use, most commonly used opioids have also been shown to affect sleep. In patients on chronic methadone, sleep architectur...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

New pharmacologic agents for insomnia and hypersomnia
Purpose of review Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates. Recent findings Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin recepto...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Drug-induced sleep endoscopy: techniques, interpretation and implications
Purpose of review The purpose of this article is to highlight recent advances in the burgeoning field of drug-induced sleep endoscopy (DISE). Recent findings One of the first studies to investigate the correlation of DISE findings and natural sleep endoscopy found good agreement in clinically significant obstruction. Previous studies have shown good agreement of DISE findings with the use of different sedative agents implying that the choice of sedative may not be crucial. However, recent studies show variable patterns of collapse, especially at the tongue base, with the use of different sedative agents. A universally...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Respiratory and sleep-related complications of multiple system atrophy
Purpose of review The purpose of this article is to provide a contemporary review of sleep issues affecting patients with multiple system atrophy (MSA). Recent findings Prodromal symptoms of MSA may occur years prior to diagnosis, including autonomic dysfunction such as orthostatic hypotension, urogenital dysfunction, rapid eye movement (REM) sleep behavior disorder (RBD), and stridor. Patients may also develop sleep-related respiratory disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA), and stridor. The development of stridor is associated with a shortened lifespan and sudden death, which may ...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Endotypes and phenotypes in obstructive sleep apnea
Purpose of review The purpose of this review is to describe the variability of obstructive sleep apnea (OSA), both from a standpoint of underlying mechanisms and in terms of clinical manifestations. Recent findings Recent data suggest that not all patients with sleep apnea get their disease for the same reason. As such, no one variable is effective at defining which patients do or do not have sleep apnea. Identifying the mechanism(s) underlying OSA for an individual is helpful as it can help to determine whether personalized therapy could be developed based on an individual's characteristics. In addition, these underl...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Looking into the future of sarcoidosis: what is next for treatment?
Purpose of review Sarcoidosis is a complex granulomatous disease of unknown cause. Corticosteroids and immune suppressants are often given long term in chronic disease, which may result in substantial toxicity. Validated strategies for selecting patients at risk for disease progression, who might benefit from early and targeted treatment, are lacking. Consequently, the unmet need for new treatment options in sarcoidosis is high. In this review, we critically discuss potential therapeutic targets and ongoing clinical trials in sarcoidosis. Recent findings Despite the heterogeneous clinical manifestations and the lack o...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Current treatment of sarcoidosis
Purpose of review Sarcoidosis is a granulomatous systemic disease of unknown cause where the lung is the most frequently affected organ. Therapeutic management of the disease is challenging as clinical presentation and prognosis are very heterogeneous. In the present review, we will summarize the main advances in sarcoidosis therapy. Recent findings Current sarcoidosis therapies are categorized in three lines: glucocorticoids (first line), immunosuppressants (second line), and biologics (third line). Recent glucocorticoid studies have reported that efficacy could be similar with high and low doses, but with an increas...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

An update on sarcoidosis-associated pulmonary hypertension
Purpose of review Pulmonary hypertension in sarcoidosis is a well known entity. Sarcoidosis-associated pulmonary hypertension (SAPH) incurs substantial morbidity and mortality. This review examines recent literatures published on epidemiology, prognosis and therapeutic management in SAPH. Recent findings Several registries have been published between 2017 and 2020. The consensus conclusion – SAPH is a harbinger for poor prognosis. Several factors were noted for predicting adverse outcome in SAPH like reduced 6-min walk distance and diffusing capacity for carbon monoxide. Given its adverse outcome, experts have n...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Advanced pulmonary sarcoidosis
Purpose of review Mortality in patients with sarcoidosis has primarily been attributed to advanced pulmonary sarcoidosis. This review aims to provide an update on recent clinical studies that help to better phenotype these patients, discuss new treatment options, and suggest areas where additional research is needed. Recent findings Diagnosis and management of advanced pulmonary sarcoidosis has changed as new technologies and treatment options have emerged. Clinical phenotypes of advanced disease have evolved to show overlap in presentation with other interstitial lung diseases. Assessment involves more advanced imagi...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Socioeconomic determinants and disparities in sarcoidosis
Purpose of review The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities. Recent findings Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and female...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Molecular profiling in sarcoidosis
Purpose of review Sarcoidosis is a systemic disease characterized by granulomatous inflammation of unknown cause. There is extensive heterogeneity between patients with respect to the number and types of organs involved, disease course, and response to therapy. Recent research in the field has leveraged ‘omics’ techniques such as transcriptomics to identify important ‘molecular profiles’ in the disease. These tools may help in identifying clinically useful biomarkers and targets for therapy. Recent findings Several studies have used gene expression profiling of predesignated lists or the entire...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Experimental models of sarcoidosis: where are we now?
Purpose of review Sarcoidosis remains a mysterious disease that presents many challenges both in pathogenetic understanding and in the management of patients. This review presents experimental models for sarcoidosis developed since 2016 and discusses their strengths and weaknesses and how they have contributed to the understanding and therapeutic approaches in this disease. In addition, future directions are proposed to overcome the limitations of current models. Recent findings New cellular models using infectious antigen as trigger, and transgenic models in mice have recently been developed to study signaling pathwa...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Recent advances in sarcoidosis genomics: epigenetics, gene expression, and gene by environment (G × E) interaction studies
Purpose of review We aim to review the most recent findings in genomics of sarcoidosis and highlight the gaps in the field. Recent findings Original explorations of sarcoidosis subphenotypes, including cases associated with the World Trade Center and ocular sarcoidosis, have identified novel risk loci. Innovative gene--environment interaction studies utilizing modern analytical techniques have discovered risk loci associated with smoking and insecticide exposure. The application of whole-exome sequencing has identified genetic variants associated with persistent sarcoidosis and rare functional variations. A single epi...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Immunology of sarcoidosis: old companions, new relationships
Purpose of review The immune determinants of granuloma formation and disease progression in sarcoidosis have not been completely disclosed, and the role of both innate and the adaptive immunity is still under investigation. Recent findings M2 macrophage polarization, previously thought to be a specific feature of a progressing and fibrosing disease, has been related to the initial steps of granuloma formation both in animal and in-vitro models. The dysregulation of specific metabolic pathways and autophagy has been associated with disease activity and progression. T cells have been reported to be strongly influenced b...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Sarcoidosis epidemiology: recent estimates of incidence, prevalence and risk factors
Purpose of review The aim of this review is to describe the latest studies on sarcoidosis incidence, prevalence and risk factors with a special focus on reports in the last 2 years. The potential biases affecting these studies are discussed. Recent findings The prevalence and incidence of sarcoidosis vary greatly depending on region of the world. Variations in data sources and settings can affect estimates of the burden of sarcoidosis, sometimes making them difficult to compare across countries. It is not well understood how the distribution of sarcoidosis phenotypes differs across populations. Age, sex and race are t...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

The future is now: a generation of sarcoidologists emerges
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Advances in lung transplantation for interstitial lung diseases
Purpose of review Lung transplantation (LTx) is increasingly used as ultimate treatment modality in end-stage interstitial lung diseases (ILDs). This review aims to give an overview of the latest evolutions in this field. Recent findings In the last two years, important new findings regarding LTx outcomes in specific ILD entities have been reported. More data are available on optimization of pre-LTx management of ILD patients especially with regard to pretransplant antifibrotic treatment. Summary LTx is the only treatment option with curative intent for ILDs and is increasingly used for this indication. Several stu...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research

Insights into pathogenesis and clinical implications in myositis-associated interstitial lung diseases
Purpose of review Interstitial lung diseases (ILDs) have been reported to be associated with myositis (including polymyositis and dermatomyositis). These myositis-associated ILDs carry significant morbidity and mortality. This review summarizes recent findings on myositis-associated ILD with a focus on pathogenesis and emerging treatment. Recent findings Recent advances in genetics have revealed 22 myositis-associated genome-wide loci, which were significantly enriched in regulatory regions in immune cells. An analysis of such disease-associated loci elucidated potential drug targets (e.g., TYK2 targeted by tofacitini...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: INTERSTITIAL LUNG DISEASE: Edited by Bruno Crestani and Martin R.J. Kolb Source Type: research