Role of antioxidants in the treatment of gastroesophageal reflux disease-associated idiopathic pulmonary fibrosis
Purpose of review Idiopathic pulmonary fibrosis (IPF) is a terminal lung disease of largely unknown cause. Gastroesophageal reflux disease (GERD) was recently discovered to be a trigger for the development of IPF. The current pharmaceutical approach to IPF falls short and there is a pressing need for improved therapeutic options. The present review describes the currently available knowledge regarding the role of oxidative stress and inflammation in the pathophysiology of IPF and GERD and determines the potential use of antioxidants as a treatment option for GERD-associated IPF. Recent findings IPF and GERD share a si...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NUTRITION AND DRUGS: Edited by Aalt Bast Source Type: research

Interaction of diet and drugs in lung disease
Purpose of review The current review aims to seek attention for the interaction between drugs and nutrition. Traditionally, drugs and nutrition are regarded as separate categories. Nutrition is to maintain health and drugs are for curing disease. Dieticians deal with food and the medical doctor prescribes drugs. During the last decade, both categories are getting closer. Recent findings Some drugs used in pulmonology lead to decrease in nutrients. Other drugs negatively affect taste. This is remarkable because the diseases for which these drugs are intended, benefit from nutrition. Gradually examples emerge that sugge...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NUTRITION AND DRUGS: Edited by Aalt Bast Source Type: research

What's new in endobronchial ultrasound for mediastinal staging?
Purpose of review The essential role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in lung cancer diagnosis and staging is now well established. With a growing body of evidence seen over the last decade, the objective of this article was to review the newest findings, provide evidence-based guidance to clinicians and identify areas for future research related to EBUS-TBNA and staging in lung cancer. Recent findings Recent literature regarding EBUS-TBNA for lung cancer staging was reviewed, with a focus on evidence published subsequent to the 2016 guideline on technical aspects of EBUS...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

Management of malignant pleural effusions
This article provides a summary of the most up-to-date evidence in this area. Recent findings Recent publications have demonstrated comparable pleurodesis outcomes of talc slurry to talc poudrage and explore strategies to combine the advantages of indwelling pleural catheters (IPCs) with a chemical pleurodesis. A daily IPC drainage regime improves the chances of pleurodesis success and early IPC removal in patients without significant trapped lung. Summary MPE is a diverse condition, with no one strategy representing the ‘best’ approach for all. Management decisions should be made in conjunction with the ...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

Pneumonitis associated with immune checkpoint inhibitors among patients with non-small cell lung cancer
Purpose of review Patients with lung cancer are particularly vulnerable to lung injury associated with immune checkpoint inhibition and often present with more frequent and more severe manifestations of lung disease compared to patients with other tumor types. The present review explores the reasons for increased susceptibility to immune checkpoint-related lung injury among this group of patients and focuses on the current knowledge of the clinical and radiologic manifestations of lung injury associated with immune checkpoint blockade and current treatment strategies. Recent findings Recent investigations have shown t...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

A contemporary review of radiation pneumonitis
Purpose of review The current article reviews recent literature and summarizes the current understanding, diagnosis, risk, predictors, and management of radiation pneumonitis. Recent findings We discuss the different parameters that contribute to radiation toxicity, the potential biomarkers that predict the risk, and mitigators of radiation pneumonitis. Summary Radiotherapy aims to provide care and a better quality of life in cancer patients however with complications. Radiation pneumonitis is important to recognize to appropriately plan and care for this population. (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

Approach to stage IV non-small-cell lung cancer: how to select among first-line therapy options?
Purpose of review There are several first-line systemic therapy options for patients with newly diagnosed stage IV non-small-cell lung cancer. Targeted therapy with tyrosine kinase inhibitors provide a good first option for some. Unfortunately, most patients do not have an alteration for which there is an available tyrosine kinase inhibitor. For these patients there are immunotherapy and chemoimmunotherapy options; however, there is debate about how to choose amongst these treatments for a given individual. This review attempts to simplify this decision-making process. Recent findings The data on first-line immunother...
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: NEOPLASMS OF THE LUNG: Edited by Alan M. Fein and David E. Ost Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - June 5, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Human global and population-specific genetic susceptibility to Mycobacterium tuberculosis infection and disease
Purpose of review Multiple lines of evidence support a role of the host genetic component in Mycobacterium tuberculosis infection and disease progression. However, genomic studies of tuberculosis susceptibility have been disappointing compared with that of other complex disorders. Recently the field has explored alternative strategies to facilitate locus discovery. Results emanating from these efforts during the last 18 months are addressed in this review. Recent findings There has been a renewed focus on the refinement of phenotypic definitions of infection and disease as well as on age-related, sex-specific and popu...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

ABCA3 mutations in adult pulmonary fibrosis patients: a case series and review of literature
Purpose of review The current review aims to recognize the variability in clinical presentation of adult patients with bi-allelic ABCA3 mutations, create more depth in ABCA3 mutations reported and highlight the influence of environmental factors on disease course. Recent findings Mutations in ABCA3 are predominantly linked to neonatal and pediatric interstitial lung disease (ILD) with a minority surviving beyond puberty. Here, we present three patients with ABCA3 mutations who present with disease at the age of 19, 61 and 77. Moreover, we identified c.4451G>C (p.R1484P), c.1675G>A (p.G559R) and c.4745C>G (p.T...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

MicroRNAs: future biomarkers and targets of therapy in asthma?
Purpose of review MicroRNAs (miRNAs) are small noncoding RNA molecules that are considered one of the fundamental regulatory mechanisms of gene expression. They are involved in many biologic processes, such as signal transduction, cell proliferation and differentiation, apoptosis and stress responses. The purpose of this review is to present recent knowledge about the role of miRNAs in asthma and outline possible applications of miRNAs. Recent findings A core set of miRNAs involved in asthma includes downregulated let-7 family, miR-193b, miR-375 as well as upregulated miR-21, miR-223, miR-146a, miR-142-5p, miR-142-3p,...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

TBX4 variants and pulmonary diseases: getting out of the ‘Box’
Purpose of review In 2013, the association between T-Box factor 4 (TBX4) variants and pulmonary arterial hypertension (PAH) has first been described. Now – in 2020 – growing evidence is emerging indicating that TBX4 variants associate with a wide spectrum of lung disorders. Recent findings TBX4 variants are enriched in both children and adults with PAH. The clinical phenotype associated with a TBX4 variant seems to be milder than that in other PAH-associated gene mutations. Further, TBX4 variants have increasingly been associated with a variety of clinical and histopathological phenotypes, including lethal...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Pharmacogenetics of antitumor necrosis factor therapy in severe sarcoidosis
Purpose of review Antitumor necrosis factor (TNF) treatment is an effective third-line treatment option in severe sarcoidosis. But not all patients respond to treatment. Pharmacogenetics studies the influence of genetic variations on treatment response. Recent findings In sarcoidosis, only one study reported on a relationship between genetic variation in TNF and response to anti-TNF therapy. In immune-mediated inflammatory diseases (IMIDs) other than sarcoidosis, several genetic variants were associated with response to anti-TNF therapy. Genes related to TNF, the target of this group of drugs, and the pathway by which...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: GENETICS: Edited by Coline H.M. van Moorsel Source Type: research

Beyond antibiotics for pulmonary nontuberculous mycobacterial disease
Purpose of review Pulmonary nontuberculous mycobacterial disease (NTM) remains a significant clinical challenge with suboptimal therapy. This review focuses on recent understandings around the pathogenesis of NTM disease and nonantibiotic therapeutic approaches that are being pursued. Recent findings The absence of animal models that truly replicate human disease remains a major problem for NTM research with most findings coming from tuberculosis or tuberculosis-like studies. Recent research reiterates the known key roles of interferon gamma (IFNγ), tumor necrosis factor, interleukin-12 and granulocyte-macrophag...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Strategies for prediction of drug-resistant pathogens and empiric antibiotic selection in community-acquired pneumonia
Purpose of review Although most patients with community-acquired pneumonia (CAP) are appropriately treated with narrow-spectrum antibiotics, predicting which patients require coverage of drug-resistant pathogens (DRP) remains a challenge. The 2019 American Thoracic Society/Infectious Diseases Society of America CAP guidelines endorse using locally validated prediction models for DRP. Here we review risk factors for DRP and provide a summary of available risk prediction models. Recent findings Both inadequate initial empiric spectrum as well as unnecessary broad-spectrum antibiotic use are associated with poor outcomes...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Advances in molecular diagnostic tests for pneumonia
Purpose of review Pneumonia is the main global cause of sepsis, and has been associated with high morbidity and high short and long-term mortality rates. As it may be caused by a wide spectrum of microorganisms, microbial diagnosis is challenging and the choice of adequate therapy remains an important problem. This review focuses on recently published studies of microbiological diagnostic tests and clinical assessments for pneumonia, including community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. Recent findings Over the past decade, the microbiological diagnosis of pneumonia ...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

New biomarkers for respiratory infections
Purpose of review Although pneumonia, either community or hospital-acquired, is the most frequent severe respiratory infection, it is an infection difficult to diagnose. At present, the diagnosis of pneumonia relies on a combination of clinical, radiologic, and microbiologic criteria. However, these criteria are far from perfect leading to uncertainty in the diagnosis, risk stratification, and choice of antibiotic therapy. Biomarkers have been used to bring additional information in this setting. Recent findings The aim of this review is to provide a clear overview of the current evidence for biomarkers to distinguish...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Pneumococcal virulence factors in community-acquired pneumonia
Purpose of review This manuscript reviews the recent literature related to new developments in the understanding of existing and novel virulence factors of the pneumococcus that are of potential importance in the development of novel preventive and therapeutic strategies. Recent findings The pneumococcal capsule and pneumolysin have long been recognized as being two of the most prominent virulence factors, with much recent research having revealed previously unrecognized mechanisms by which they contribute to the pathogenesis of infection. Although the pneumococcal capsule has been considered a sine qua non for virule...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Influenza management with new therapies
We examined both pharmacological and supportive treatment strategies currently available to see how they might be applied in an ICU setting. Recent findings Supportive care in Influenza centres around optimizing respiratory failure, particularly through well established and recognized ventilatory strategies. Noninvasive ventilation and high-flow nasal oxygen may have a limited role in selected patients under carefully monitored circumstances. Drug therapy exerts only a modest clinical effect and has been poorly studied in the critically ill, though there is some evidence to support the use of neuraminidase inhibitors (N...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Viral respiratory infections: a cause of community-acquired pneumonia or a predisposing factor?
Purpose of review A cause for community-acquired pneumonia (CAP) is only identified in ∼50% of cases. Nasopharyngeal PCR panels contain more viruses than previously. The problem then becomes determining the relevance of the organisms identified rather than figuring out which virus is present. This review addresses how to distinguish between viral CAP and bacterial CAP, how viral CAP predisposes to bacterial CAP and some novel antiviral treatment being conducted. Recent findings The pneumonia severity index has been studied in patients with viral CAP. There are new studies using biomarkers to help determine when an...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Update in adult community-acquired pneumonia: key points from the new American Thoracic Society/Infectious Diseases Society of America 2019 guideline
Purpose of review The American Thoracic Society and Infectious Diseases Society of America recently released their joint guideline for the diagnosis and treatment of adults with community-acquired pneumonia (CAP). The co-chairs of the guideline committee provide a summary of the guideline process, key recommendations from the new guideline and future directions for CAP research. Recent findings The guideline committee included 14 experts from the two societies. Sixteen questions for the guideline were selected using the PICO format. The GRADE approach was utilized to review the available evidence and generate recommen...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Transmission of respiratory tract infections at mass gathering events
Purpose of review Mass gathering events bring people from across all continents increasing the risk of spread of aerosol transmissible respiratory tract infections. Respiratory tract infections for instance in pilgrims attending the world's largest recurring annual pilgrimage, the Hajj are common. We review recent literature on viral and bacterial infectious diseases with special focus on the Hajj. Recent findings The prevalence of bacterial and viral infections continue to increase, because of the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus infl...
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Editorial: The explosive epidemic outbreak of novel coronavirus disease 2019 (COVID-19) and the persistent threat of respiratory tract infectious diseases to global health security
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: INFECTIOUS DISEASES: Edited by Michael S. Niederman and Alimuddin Zumla Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - April 2, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Yoga and Tai Chi: a mind–body approach in managing respiratory symptoms in obstructive lung diseases
Purpose of review Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation because of airway and/or alveolar abnormalities. Symptoms include dyspnea, cough, chronic sputum production. As the third-ranked cause of death as well as disability-adjusted life years (DALYs), it poses a significant burden on patients, families, healthcare system and society. Regular physical activity is linked to decrease in morbidity and mortality associated with COPD, but implementation remains challenging. There is a need for community-based interventions that promote physical activity. Yoga and Tai Chi are widely ...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Noninvasive positive pressure ventilation in stable patients with COPD
Purpose of review Long-term noninvasive positive pressure ventilation (NIV) used to be a controversial form of therapy for patients with stable hypercapnic chronic obstructive pulmonary disease (SH-COPD). New evidence described in this review defines the optimal settings, timing and target population for NIV utilization in SH-COPD necessary to maximize its benefit. Recent findings NIV, when titrated appropriately, leads to improved clinical outcomes. High inspiratory positive airway pressures aimed at decreasing CO2 levels can ensure NIV success in SH-COPD. NIV initiated when patients remain hypercapnic whereas in a c...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Eosinophils in chronic obstructive pulmonary disease: are they just another biomarker?
Purpose of review Interest in blood eosinophils as a biomarker of responsiveness to therapy in chronic obstructive pulmonary disease (COPD) continues to grow, with recommendations regarding their adjunctive use incorporated into the GOLD 2019 treatment algorithm. The present review summarizes some key recent papers referencing differential treatment effects based on blood eosinophil counts. Recent findings Post-hoc analyses of trials of inhaled corticosteroids in COPD have shown greater treatment responses in patients with higher blood eosinophil levels, with some exceptions. Eosinophil-directed treatment with oral co...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Small airway disease in chronic obstructive pulmonary disease: insights and implications for the clinician
Purpose of review Small airway disease (SAD) is a common feature in chronic obstructive pulmonary disease (COPD) patients. Chronic exposure to cigarette smoking causes inflammation, damage, tissue remodelling and eventually airway loss. These features lead to airflow limitation and defective alveolar ventilation. The aim of this review is to provide clinicians with an up-to-date perspective of SAD in COPD. Recent findings In this review, we will discuss the key pathological features of SAD. We also review state-of-the-art techniques for measuring SAD, including impulse oscillometry and lung imaging methods. We discuss...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Asthma–COPD overlap: review of diagnosis and management
Purpose of review Asthma and chronic obstructive pulmonary disease are both commonly encountered respiratory conditions. The term asthma--COPD overlap (ACO) has been used to identify patients presenting with features of both conditions. Controversy exists regarding its definition, approach to diagnosis and management. In this publication, recent evidence has been reviewed that provides insight into diagnosis and management of this condition. Recent findings Previously, multiple criteria were used to define Asthma--COPD overlap. In this publication, the most recent guidelines to identify this condition have been review...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Adherence to Global Initiative for Chronic Obstructive Lung Disease guidelines in the real world: current understanding, barriers, and solutions
Purpose of review The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides a comprehensive review and guidance for clinicians managing patients with chronic obstructive pulmonary disease (COPD). However, adherence to GOLD guidelines has been suboptimal over the years. The current review summarizes the current body of literature addressing the multitude of reasons for the lack of adherence to GOLD guidelines in clinical practice. Recent findings There continue to be several reasons for suboptimal adoption of GOLD guidelines in clinical practice. A primary and recurrent theme appears to be both delayed...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Occupational lung diseases in the 21st century: the changing landscape and future challenges
Purpose of review Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century. Recent findings Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as si...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Coal mining and lung disease in the 21st century
Purpose of review To review the impact of coal mining and resurgence of coal workers’ pneumoconiosis (CWP) in 21st century and effect of ambient air pollution on lung function. Recent findings At the beginning of 21st century, statistics by National Institute for Occupational Safety and Health showed a steep rise in pneumoconiosis. This was followed by numerous epidemiologic and pathologic studies that confirmed increasing CWP prevalence as well as disease in younger miners and those with a shorter mining tenure. Recent studies have demonstrated that poor dust control in mines, a relative shift in composition of...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Household air pollution in India and respiratory diseases: current status and future directions
Purpose of review Combustion of solid cooking fuels employed by more than 3 billion people globally, contributes to approximately one third of ambient air pollution. In the recent past, the issue has drawn global attention because of its threat to the health of rural communities, particularly women and children. This review is focused on the evidence from India on effects of household air pollution (HAP) on respiratory health and interventions to replace the solid fuels. Recent findings HAP exposure is a major risk factor for increased respiratory symptoms, respiratory infections, and chronic obstructive pulmonary dis...
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Climate change and respiratory diseases: a 2020 perspective
This article summarizes some of those studies. Summary The clarity of our vision with respect to the dramatic impact of climate change upon human respiratory health approaches 20/20. The data represent a mandate for change. Change needs to include international, national, and individual efforts. (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Editorial: Acute respiratory illness caused by vaping
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Editorial: Timely topical reviews on climate change, indoor air pollution, coalworkers’ pneumoconiosis, and chronic obstructive pulmonary disease
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 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, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Exercise and lifestyle changes in pediatric asthma
Purpose of review The purpose of this review is to discuss the most recent studies on lifestyle interventions in pediatric asthma. We include studies on physical activity and exercise, sedentary time, nutrition, behavioral therapy and the role of schools. Recent findings Several small studies in children with asthma suggest that exercise interventions can improve aerobic fitness, asthma symptoms or control and quality of life. Existing evidence supports recommending higher intake of fruits and vegetables for asthma risk and control. In contrast, the ‘Western diet’ – high in refined grains, highly pro...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

How harmless are E-cigarettes? Effects in the pulmonary system
Purpose of review Electronic cigarettes have quickly risen to be the leading alternative nicotine source to tobacco. E-cigarette use is hard to research and regulate because of the novelty and rapid evolution of the devices and E-liquids. Epidemiological data on long-term usage is currently lacking, but in smaller cohort studies we are starting to understand the usage patterns and demographics of users, which differ depending on where the study takes place and the regulatory environment. The present review describes the current knowledge of the effects of E-cigarettes on the pulmonary system and knowledge of their usage ...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The burden of corticosteroid overload in severe and difficult to treat asthma: how to reduce this?
Purpose of review Severe asthma is a serious condition that requires an individualized approach combining several treatment agents administered simultaneously in order to reach adequate control. Glucocorticosteroid treatment, as the cornerstone of asthma pharmacotherapy, has great disease-controlling capability, although it may induce a vast amount of severe adverse effects. This review describes our current knowledge of the monitoring and managing options of these adverse effects and possibilities to prevent them, including new therapeutic options. Recent findings A large amount of new drugs is emerging, which may of...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The role of genomic profiling in identifying molecular phenotypes in obstructive lung diseases
Purpose of review The biology underlying asthma and chronic obstructive pulmonary disease (COPD) is heterogeneous. Targeting therapies to patient subgroups, or ‘molecular phenotypes’, based on their underlying biology is emerging as an efficacious treatment strategy. This review summarizes the role of airway sample gene expression profiling in understanding molecular phenotypes in obstructive lung disease. Recent findings Recent gene expression studies have reinforced the importance of Type two (T2) inflammation in asthma and COPD subgroups. Studies in asthma also suggest that the molecular phenotype with ...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Precision medicine in severe pediatric asthma: opportunities and challenges
Purpose of review Severe pediatric asthma exerts a substantial burden on patients, their families and society. This review provides an update on the latest insights and needs regarding the implementation of precision medicine in severe pediatric asthma. Recent findings Biologicals targeting underlying inflammatory pathways are increasingly available to treat children with severe asthma, holding the promise to enable precision medicine in this heterogeneous patient population with high unmet clinical needs. However, the current understanding of which child would benefit from which type or combination of biologicals is ...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Anti-alarmin approaches entering clinical trials
Purpose of review The alarmins, thymic stromal lymphopoietin (TSLP), interleukin (IL)-25 and IL-33, are upstream regulators of T2 (type 2) inflammation and found to be expressed at high levels in airway epithelium of patients with T2 asthma. This review will summarize how alarmins regulate the inflamed asthmatic airways through previously described and newly identified mechanisms. Recent findings Alarmins drive allergic and nonallergic asthma through activation of innate lymphoid cell 2 (ILC2), which are a rich source of cytokines such as IL-5 and IL-13, with resulting effects on eosinophilopoeisis and remodelling, re...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The different faces of the macrophage in asthma
Purpose of review Asthma is a chronic inflammatory disease in which changes in macrophage polarization have been shown to contribute to the pathogenesis. The present review discusses the contribution of changes in macrophage function to asthma related to polarization changes and elaborates on possible therapeutic strategies targeting macrophage function and polarization. Recent findings Macrophage function alterations were shown to contribute to asthma pathology in several ways. One is by impaired phagocytosis and efferocytosis. Another is by changing inflammation, by altered (anti)inflammatory cytokine production and...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Can training induce inflammatory control in asthma, or is it symptom control only?
Purpose of review Exercise has shown to reduce asthma symptoms; however, the underlying mechanism for this improvement remains unclear. Improvement in inflammatory control could be the reason for this reduction in symptoms. This review discusses recent studies evaluating the effect of exercise on inflammatory control in patients with asthma. Recent findings New studies support that exercise is well tolerated and feasible regardless of intensity. Exercise seems to improve systemic low-grade inflammation, but consistency lacks when it comes to reduction in airway inflammation. Summary Physical exercise as an adjuvant...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The impact of comorbidities on severe asthma
Purpose of review Severe asthma is often associated with numerous comorbidities that complicate disease management and affect patient's outcomes. They contribute to poor disease control and mimic asthma symptoms. Although some comorbidities such as obstructive sleep apnea, bronchiectasis, and chronic obstructive pulmonary disease are generally well recognized, many other may remain undiagnosed but may be detected in an expert specialist setting. The management of comorbidities seems to improve asthma outcomes, and optimizes therapy by avoiding overtreatment. The present review provides recent knowledge regarding the most...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Lost in transition: biomarkers of remodeling in patients with asthma
Purpose of review ‘Biomarkers of remodeling’ represent a loose collection of features referring to several biological adaptations of the lung to cope with stressing factors. In addition, remodel-’ing’ infers a dynamic process that would require a spatiotemporal resolution. This review focuses on different aspects of remodeling in pediatric and adult care. Recent findings This review will cover aspects of pediatric remodeling, adult remodeling and techniques and procedures to adequately assess remodeling across different age spectra. In pediatrics, the onset and first features of remodeling are ...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Precision medicine and treatable traits in chronic airway diseases - where do we stand?
Purpose of review To provide an update on the implementation of precision medicine, based on treatable traits and mechanisms, in the daily clinical management of chronic airways diseases. Recent findings Recent insights into the complex and heterogeneous nature of chronic airway diseases including chronic obstructive pulmonary disease (COPD) and asthma identified several clinical and inflammatory phenotypes. This shifted the management focus of these diseases away from the prototypic disease labels and paved the way for developing novel targeted therapies. The concept of precision medicine aims to link the right pati...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Ecological interactions in asthma: from environment to microbiota and immune responses
Purpose of review Asthma is a heterogeneous condition shaped not only by genetics but also host conditioning by environmental factors. Recognizing the ecological context of microbe-immune interactions across environments and body sites is a necessary step toward better understanding how human microbiota influence or drive the pathogenesis and pathophysiology of asthma in its various presentations. Recent findings There is increasing evidence of a critical role for microbiota in asthma pathogenesis and outcomes across various body compartments, including the upper and lower airways, and gut. We discuss recent studies f...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Epithelial dysfunction in chronic respiratory diseases, a shared endotype?
Purpose of review Epithelial barrier defects are being appreciated in various inflammatory disorders; however, causal underlying mechanisms are lacking. In this review, we describe the disruption of the airway epithelium with regard to upper and lower airway diseases, the role of epigenetic alterations underlying this process, and potential novel ways of interfering with dysfunctional epithelial barriers as a novel therapeutic approach. Recent findings A defective epithelial barrier, impaired innate defence mechanisms or hampered epithelial cell renewal are found in upper and lower airway diseases. Barrier dysfunction...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research