Discordant diagnostic criteria for pneumonia in COPD trials: a review
Inhaled corticosteroids (ICS) have a class effect of increasing pneumonia risk in patients with COPD. However, pneumonia incidence varies widely across clinical trials of ICS use in COPD. This review clarifies methodological differences in defining and recording pneumonia events in these trials and discusses factors that could contribute to the varying pneumonia incidence. Literature searches and screening yielded 40 relevant references for inclusion. Methods used to capture pneumonia events in these studies included investigator-reported pneumonia adverse events, standardised list of signs or symptoms, radiographic confir...
Source: European Respiratory Review - November 17, 2021 Category: Respiratory Medicine Authors: Wise, R. A., Bafadhel, M., Crim, C., Criner, G. J., Day, N. C., Halpin, D. M. G., Han, M. K., Lange, P., Lipson, D. A., Martinez, F. J., Maselli, D. J., Midwinter, D., Singh, D., Zysman, M., Dransfield, M. T., Russell, R. E. K. Tags: COPD and smoking Reviews Source Type: research

Sex and gender in interstitial lung diseases
Sex and gender differences influence key domains of research, lung health, healthcare access and healthcare delivery. In interstitial lung diseases (ILDs), mouse models of pulmonary fibrosis are clearly influenced by sex hormones. Additionally, short telomeres, a biomarker of telomere regulation gene mutations, are impacted by sex, while heritability unexplained by genetic variation may be attributable to gendered environmental factors that drive epigenetic control. Diseases like idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, occupational ILDs, connective tissue-associated ILDs and lymphangioleiomyomatosis ha...
Source: European Respiratory Review - November 17, 2021 Category: Respiratory Medicine Authors: Kawano-Dourado, L., Glassberg, M. K., Assayag, D., Borie, R., Johannson, K. A. Tags: Interstitial and orphan lung disease Sex and gender in lung disease Source Type: research

Aspergillus-related lung disease in people with cystic fibrosis: can imaging help us to diagnose disease?
In people with cystic fibrosis (PwCF), viscous sputum and dysfunction of the mucociliary escalator leads to early and chronic infections. The prevalence of Aspergillus fumigatus in sputum is high in PwCF and the contribution of A. fumigatus to the progression of structural lung disease has been reported. However, overall, relatively little is known about the contribution of A. fumigatus to CF lung disease. More knowledge is needed to aid clinical decisions on whether to start antifungal treatment. In this review, we give an overview of A. fumigatus colonisation and infection in PwCF and the different types of pulmonary dis...
Source: European Respiratory Review - November 17, 2021 Category: Respiratory Medicine Authors: Lv, Q., Elders, B. B. L. J., Warris, A., Caudri, D., Ciet, P., Tiddens, H. A. W. M. Tags: CF and non-CF bronchiectasis Reviews Source Type: research

Sex and gender in asthma
Asthma is a heterogenous disease, and its prevalence and severity are different in males versus females through various ages. As children, boys have an increased prevalence of asthma. As adults, women have an increased prevalence and severity of asthma. Sex hormones, genetic and epigenetic variations, social and environmental factors, and responses to asthma therapeutics are important factors in the sex differences observed in asthma incidence, prevalence and severity. For women, fluctuations in sex hormone levels during puberty, the menstrual cycle and pregnancy are associated with asthma pathogenesis. Further, sex differ...
Source: European Respiratory Review - November 17, 2021 Category: Respiratory Medicine Authors: Chowdhury, N. U., Guntur, V. P., Newcomb, D. C., Wechsler, M. E. Tags: Asthma and allergy Sex and gender in lung disease Source Type: research

Clinical utility of diagnostic biomarkers in malignant pleural mesothelioma: a systematic review and meta-analysis
Malignant pleural mesothelioma (MPM) is characterised by late-stage diagnosis and poor prognosis. Currently, no screening tool is advocated and diagnosis is based on invasive techniques, which are not well tolerated. Non-invasive diagnostic biomarkers have shown potential and could have a huge clinical benefit. However, despite extensive research, there is no consensus yet on their clinical use, with many articles reporting contradicting results, limiting their clinical implementation. The aim of this systematic review is therefore to explore the different semi- and non-invasive diagnostic markers in several human matrices...
Source: European Respiratory Review - November 17, 2021 Category: Respiratory Medicine Authors: Schillebeeckx, E., van Meerbeeck, J. P., Lamote, K. Tags: Lung biology and experimental studies Reviews Source Type: research

Sex and gender in lung health and disease: more than just Xs and Ys
Every nucleated human cell carries sex chromosomes and every person has a gender. These terms "sex" and "gender" are often used interchangeably and incorrectly in the scientific literature, but they mean different things: sex is a biological attribute associated with physical and physiological features determined by chromosomes, hormones, anatomy and gene expression; whereas gender is a sociocultural construct based on expressions of identity, behaviours and social roles [1]. Thus, sex and gender-related factors can both influence health and disease via distinct but intersecting mechanisms. There are im...
Source: European Respiratory Review - November 8, 2021 Category: Respiratory Medicine Authors: Weatherald, J., Riha, R. L., Humbert, M. Tags: Respiratory clinical practice Editorials Source Type: research

Development and clinical translation of tubular constructs for tracheal tissue engineering: a review
Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory medicine. The trachea is a 10–11 cm long fibrocartilaginous tube of the lower respiratory tract, with 16–20 tracheal cartilages anterolaterally and a dynamic trachealis muscle posteriorly. Tracheal resection is commonly offered to patients suffering from short-length tracheal defects, but replacement is required when the trauma exceeds 50% of total length of the trachea in adults and 30% in children. Recently, tissue engineering (TE) has shown...
Source: European Respiratory Review - November 8, 2021 Category: Respiratory Medicine Authors: Soriano, L., Khalid, T., Whelan, D., O'Huallachain, N., Redmond, K. C., O'Brien, F. J., O'Leary, C., Cryan, S.-A. Tags: Pulmonary pharmacology and therapeutics Reviews Source Type: research

Antineutrophil cytoplasmic antibody-associated interstitial lung disease: a review
Over the past three decades, an increasing number of publications have reported the association between interstitial lung disease (ILD) and anti-neutrophil cytoplasmic antibody (ANCA) or ANCA-associated vasculitis (AAV). With this increased awareness, we have reviewed the literature to date and provide an update in this narrative review. The vast majority of cases of ILD have been shown to be in the setting of positive anti-myeloperoxidase antibody and can be present in up to 45% of patients of microscopic polyangiitis, though cases of ILD associated with proteinase 3 ANCA have rarely been reported. Pulmonary fibrosis and ...
Source: European Respiratory Review - November 8, 2021 Category: Respiratory Medicine Authors: Kadura, S., Raghu, G. Tags: Interstitial and orphan lung disease Reviews Source Type: research

Sex and gender in respiratory physiology
Sex is a biological concept determined at conception. Gender is a social concept. Medicine recognises sex as a biological variable and recommends including sex as a factor in clinical practice norms and as a topic of bench and clinical research. Sex plays a role in respiratory physiology according to two pathways: hormones and anatomy, with females characterised by smaller dimensions at every level of the respiratory system. Sex hormones also play specific roles in lung inflammatory processes, breathing control and in response to diseases. The literature is extremely controversial because many factors need to be considered...
Source: European Respiratory Review - November 8, 2021 Category: Respiratory Medicine Authors: LoMauro, A., Aliverti, A. Tags: Mechanisms of lung disease Sex and gender in lung disease Source Type: research

Sex and gender in pulmonary arterial hypertension
This article aims to review epidemiology, mechanisms underlying the higher female predominance, but better prognosis and the intricacies in management of women affected by PAH. (Source: European Respiratory Review)
Source: European Respiratory Review - November 8, 2021 Category: Respiratory Medicine Authors: Cheron, C., McBride, S. A., Antigny, F., Girerd, B., Chouchana, M., Chaumais, M.-C., Jaïs, X., Bertoletti, L., Sitbon, O., Weatherald, J., Humbert, M., Montani, D. Tags: Pulmonary vascular disease Sex and gender in lung disease Source Type: research

COVID-19 pneumonia: pathophysiology and management
Coronavirus disease 2019 (COVID-19) pneumonia is an evolving disease. We will focus on the development of its pathophysiologic characteristics over time, and how these time-related changes determine modifications in treatment. In the emergency department: the peculiar characteristic is the coexistence, in a significant fraction of patients, of severe hypoxaemia, near-normal lung computed tomography imaging, lung gas volume and respiratory mechanics. Despite high respiratory drive, dyspnoea and respiratory rate are often normal. The underlying mechanism is primarily altered lung perfusion. The anatomical prerequisites for P...
Source: European Respiratory Review - October 20, 2021 Category: Respiratory Medicine Authors: Gattinoni, L., Gattarello, S., Steinberg, I., Busana, M., Palermo, P., Lazzari, S., Romitti, F., Quintel, M., Meissner, K., Marini, J. J., Chiumello, D., Camporota, L. Tags: Respiratory infections and tuberculosis COVID-19 Reviews Source Type: research

A role for club cells in smoking-associated lung adenocarcinoma
The cellular origin of lung adenocarcinoma remains a focus of intense research efforts. The marked cellular heterogeneity and plasticity of the lungs, as well as the vast variety of molecular subtypes of lung adenocarcinomas perplex the field and account for the extensive variability of experimental results. While most experts would agree on the cellular origins of other types of thoracic tumours, great controversy exists on the tumour-initiating cells of lung adenocarcinoma, since this histologic subtype of lung cancer arises in the distal pulmonary regions where airways and alveoli converge, occurs in smokers as well as ...
Source: European Respiratory Review - October 20, 2021 Category: Respiratory Medicine Authors: Behrend, S. J., Giotopoulou, G. A., Spella, M., Stathopoulos, G. T. Tags: Lung cancer Lung Science Conference Reviews Source Type: research

Lung cancer is also a hereditary disease
Pathogenic genetic variants (formerly called mutations) present in the germline of some individuals are associated with a clinically relevant increased risk of developing lung cancer. These germline pathogenic variants are hereditary and are transmitted in an autosomal dominant fashion. There are two major lung cancer susceptibility syndromes, and both seem to be specifically associated with the adenocarcinoma subtype. Li-Fraumeni syndrome is caused by variants in the TP53 tumour-suppressor gene. Carriers are mainly at risk of early-onset breast cancer, sarcoma, glioma, leukaemia, adrenal cortical carcinoma and lung cancer...
Source: European Respiratory Review - October 20, 2021 Category: Respiratory Medicine Authors: Benusiglio, P. R., Fallet, V., Sanchis-Borja, M., Coulet, F., Cadranel, J. Tags: Lung cancer Thoracic oncology Source Type: research

Thymic tumours and their special features
This article provides an overview of the most recent findings in the diagnosis, staging, histology, and management strategies of thymic tumours. (Source: European Respiratory Review)
Source: European Respiratory Review - October 20, 2021 Category: Respiratory Medicine Authors: Basse, C., Girard, N. Tags: Lung cancer Thoracic oncology Source Type: research

Antibiotics as immunomodulators: a potential pharmacologic approach for ARDS treatment
First described in the mid-1960s, acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure with an overall mortality rate of approximately 40%. Despite significant advances in the understanding and treatment of ARDS, no substantive pharmacologic therapy has proven to be beneficial, and current management continues to be primarily supportive. Beyond their antibacterial activity, several antibiotics such as macrolides and tetracyclines exert pleiotropic immunomodulatory effects that might be able to rectify the dysregulated inflammatory response present in patients with ARDS. This review a...
Source: European Respiratory Review - October 5, 2021 Category: Respiratory Medicine Authors: Sauer, A., Peukert, K., Putensen, C., Bode, C. Tags: Interstitial and orphan lung disease, Respiratory infections and tuberculosis Review Source Type: research

Exploring the 175-year history of spirometry and the vital lessons it can teach us today
175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry...
Source: European Respiratory Review - October 5, 2021 Category: Respiratory Medicine Authors: Kouri, A., Dandurand, R. J., Usmani, O. S., Chow, C.-W. Tags: Pulmonary pharmacology and therapeutics Review Source Type: research

Thoracic involvement and imaging patterns in IgG4-related disease
Conclusion Thoracic involvement of IgG4-RD is heterogeneous and likely underestimated. The main thoracic CT scan patterns are peribronchovascular thickening and thoracic lymph nodes. (Source: European Respiratory Review)
Source: European Respiratory Review - October 5, 2021 Category: Respiratory Medicine Authors: Muller, R., Habert, P., Ebbo, M., Graveleau, J., Groh, M., Launay, D., Audia, S., Pugnet, G., Cohen, F., Perlat, A., Benyamine, A., Bienvenu, B., Gaigne, L., Chanez, P., Gaubert, J. Y., Schleinitz, N. Tags: Lung imaging Review Source Type: research

The efficacy of immune checkpoint inhibitors in thoracic malignancies
The advent of immune checkpoint inhibitors (ICIs) has rapidly transformed the treatment paradigm for multiple cancer types, including thoracic malignancies. In advanced non-small cell lung cancer (NSCLC), ICIs have shifted treatment paradigm and improved overall survival reaching almost one-third of patients alive at 5 years. ICIs therapies have also modified the therapeutic strategy in first-line setting in metastatic small-cell lung cancer (SCLC) patients as well as in malignant pleural mesothelioma (MPM) improving the overall survival compared with standard treatment. This phenomenon is of huge relevance as both SC...
Source: European Respiratory Review - October 5, 2021 Category: Respiratory Medicine Authors: Remon, J., Facchinetti, F., Besse, B. Tags: Lung cancer Thoracic oncology Source Type: research

Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present...
Source: European Respiratory Review - October 5, 2021 Category: Respiratory Medicine Authors: Ghigna, M.-R., Thomas de Montpreville, V. Tags: Lung cancer Thoracic oncology Source Type: research

ERS/EAACI statement on adherence to international adult asthma guidelines
Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups. Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical out...
Source: European Respiratory Review - September 15, 2021 Category: Respiratory Medicine Authors: Mathioudakis, A. G., Tsilochristou, O., Adcock, I. M., Bikov, A., Bjermer, L., Clini, E., Flood, B., Herth, F., Horvath, I., Kalayci, O., Papadopoulos, N. G., Ryan, D., Sanchez Garcia, S., Correia-de-Sousa, J., Tonia, T., Pinnock, H., Agache, I., Janson, Tags: Asthma and allergy ERS/EAACI Statement Source Type: research

Platelets: a potential role in chronic respiratory diseases?
Platelets are small anucleate cells known for their role in haemostasis and thrombosis. In recent years, an increasing number of observations have suggested that platelets are also immune cells and key modulators of immunity. They express different receptors and molecules that allow them to respond to pathogens, and to interact with other immune cells. Platelets were linked to the pathogenesis of some inflammatory disorders including respiratory diseases such as asthma and idiopathic pulmonary fibrosis. Here, we discuss the involvement of platelets in different immune responses, and we focus on their potential role in vari...
Source: European Respiratory Review - September 15, 2021 Category: Respiratory Medicine Authors: Chebbo, M., Duez, C., Alessi, M. C., Chanez, P., Gras, D. Tags: Lung biology and experimental studies, Mechanisms of lung disease Review Source Type: research

Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
Acute respiratory distress syndrome (ARDS) is a serious complication of severe systemic or local pulmonary inflammation, such as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ARDS is characterised by diffuse alveolar damage that leads to protein-rich pulmonary oedema, local alveolar hypoventilation and atelectasis. Inadequate perfusion of these areas is the main cause of hypoxaemia in ARDS. High perfusion in relation to ventilation (V/Q
Source: European Respiratory Review - September 15, 2021 Category: Respiratory Medicine Authors: Gierhardt, M., Pak, O., Walmrath, D., Seeger, W., Grimminger, F., Ghofrani, H. A., Weissmann, N., Hecker, M., Sommer, N. Tags: Acute lung injury and critical care Review Source Type: research

The cystic fibrosis lung microenvironment alters antibiotic activity: causes and effects
We describe how the CF lung microenvironment, shaped by host factors (such as iron, mucus, immune mediators and oxygen availability) and the microbiota, influences antibiotic activity and varies widely between patients. A better understanding of the CF microenvironment and population diversity may thus help improve in vitro antibiotic susceptibility testing and clinical decision making, in turn increasing the success rate of antibiotic treatment. (Source: European Respiratory Review)
Source: European Respiratory Review - September 15, 2021 Category: Respiratory Medicine Authors: Van den Bossche, S., De Broe, E., Coenye, T., Van Braeckel, E., Crabbe, A. Tags: CF and non-CF bronchiectasis Review Source Type: research

Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications
There is well established evidence that the minute ventilation (V'E)/carbon dioxide output (V'CO2) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V'E/V'CO2 reflects an enlarged physiological dead space ("wasted" ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V'E/V'CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved ...
Source: European Respiratory Review - September 15, 2021 Category: Respiratory Medicine Authors: Neder, J. A., Berton, D. C., Phillips, D. B., O'Donnell, D. E. Tags: COPD and smoking, Mechanisms of lung disease Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders Source Type: research

Minute ventilation/carbon dioxide production in congenital heart disease
This review summarises various applications of how ventilatory equivalent (ventilatory efficiency or better still ventilatory inefficiency) and the minute ventilation (V'E)/carbon dioxide production (V'CO2) slope obtained from cardiopulmonary exercise testing (CPET) can be used in the diagnostic or prognostic workup of patients with congenital heart disease. The field of congenital heart disease comprises not only a very heterogeneous patient group with various heart diseases, but also various conditions in different stages of repair, as well as the different residuals seen in long-term follow-up. As such, various physiolo...
Source: European Respiratory Review - September 15, 2021 Category: Respiratory Medicine Authors: Hager, A. Tags: Mechanisms of lung disease Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders Source Type: research

Recycling plastic: diagnosis and management of plastic bronchitis among adults
Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Plastic bronchitis is most often encountered in the paediatric population following corrective cardiac surgery, such as the Fontan procedure. It also occurs in adults. Plastic bronchitis in adults is rare, heterogeneous in its aetiology, and can lead to respiratory distress or even ...
Source: European Respiratory Review - August 17, 2021 Category: Respiratory Medicine Authors: Ntiamoah, P., Mukhopadhyay, S., Ghosh, S., Mehta, A. C. Tags: Interstitial and orphan lung disease Review Source Type: research

Cryptogenic organising pneumonia: current understanding of an enigmatic lung disease
Organising pneumonia (OP) is currently recognised as a nonspecific lung injury response that is associated with a variety of imaging patterns obtained with high-resolution computed tomography (HRCT) of the chest and is characterised histopathologically by the presence of inflammatory cells and a connective tissue matrix within distal airspaces of the lungs. OP is associated with many conditions that include connective tissue disorders, various infections, drug reactions, hypersensitivity pneumonitis and aspiration. When OP cannot be linked to an associated condition and appears to be idiopathic, it is termed cryptogenic or...
Source: European Respiratory Review - August 17, 2021 Category: Respiratory Medicine Authors: Raghu, G., Meyer, K. C. Tags: Interstitial and orphan lung disease Review Source Type: research

Pulmonary hypertension phenotypes in patients with systemic sclerosis
Pulmonary hypertension (PH) commonly affects patients with systemic sclerosis (SSc) and is associated with significant morbidity and increased mortality. PH is a heterogenous condition and several different forms can be associated with SSc, including pulmonary arterial hypertension (PAH) resulting from a pulmonary arterial vasculopathy, PH due to left heart disease and PH due to interstitial lung disease. The incidence of pulmonary veno-occlusive disease is also increased. Accurate and early diagnosis to allow optimal treatment is, therefore, essential. Recent changes to diagnostic haemodynamic criteria at the 6th World Sy...
Source: European Respiratory Review - August 17, 2021 Category: Respiratory Medicine Authors: Haque, A., Kiely, D. G., Kovacs, G., Thompson, A. A. R., Condliffe, R. Tags: Pulmonary vascular disease Review Source Type: research

A scoping review of palliative care outcome measures in interstitial lung disease
Interstitial lung disease (ILD) confers a high mortality and symptom burden, substantially impacting quality of life. Studies evaluating palliative care in ILD are rapidly expanding. Uniform outcome measures are crucial to assessing the impact of palliative care in ILD. This scoping review evaluates existing outcome measures in general health-related quality of life (HRQoL), physical health, mental health, social health and advance care planning (ACP) domains in patients with ILD. Articles in English with quantitative assessment of at least one measure of general HRQoL, physical health, mental health, social health or ACP ...
Source: European Respiratory Review - August 3, 2021 Category: Respiratory Medicine Authors: Gersten, R. A., Moale, A. C., Seth, B., Vick, J. B., Brown, H., Eakin, M. N., Mathai, S. C., Danoff, S. K. Tags: Interstitial and orphan lung disease Review Source Type: research

Airway granulation response to lung-implantable medical devices: a concise overview
Increasing numbers of endoscopically implantable devices are implanted in the airways, such as airway stents, one-way valves and coils, to treat both malignant and benign diseases. They significantly improve patient outcomes, but their long-term effectiveness and sustainability is hampered by the reaction of the formation of granulation tissue. Factors including procedural-related tissue injury; micro-organism presence; device-related factors, such as the material, design and sizing in relation to the airway; and patient-related factors, including genetic susceptibility, comorbidities and medication use, might all effect t...
Source: European Respiratory Review - August 3, 2021 Category: Respiratory Medicine Authors: Roodenburg, S. A., Pouwels, S. D., Slebos, D.-J. Tags: Pulmonary pharmacology and therapeutics Review Source Type: research

Human pluripotent stem cells for the modelling and treatment of respiratory diseases
Respiratory diseases are among the leading causes of morbidity and mortality worldwide, representing a major unmet medical need. New chemical entities rarely make it into the clinic to treat respiratory diseases, which is partially due to a lack of adequate predictive disease models and the limited availability of human lung tissues to model respiratory disease. Human pluripotent stem cells (hPSCs) may help fill this gap by serving as a scalable human in vitro model. In addition, human in vitro models of rare genetic mutations can be generated using hPSCs. hPSC-derived epithelial cells and organoids have already shown grea...
Source: European Respiratory Review - August 3, 2021 Category: Respiratory Medicine Authors: Goldsteen, P. A., Yoseif, C., Dolga, A. M., Gosens, R. Tags: Lung biology and experimental studies Review Source Type: research

Lung transplantation for interstitial lung disease
Lung transplantation (LTx) can be a life-extending treatment option for patients with advanced and/or progressive fibrotic interstitial lung disease (ILD), especially idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis, sarcoidosis and connective tissue disease-associated ILD. IPF is now the most common indication for LTx worldwide. Several unique features in patients with ILD can impact optimal timing of referral or listing for LTx, pre- or post-transplant risks, candidacy and post-transplant management. As the epidemiology of LTx and community practices have evolved, recent literature describes out...
Source: European Respiratory Review - August 3, 2021 Category: Respiratory Medicine Authors: Kapnadak, S. G., Raghu, G. Tags: Interstitial and orphan lung disease Review Source Type: research

Tuberous sclerosis complex for the pulmonologist
Tuberous sclerosis complex (TSC) is a rare multisystem genetic disorder affecting almost all organs with no sex predominance. TSC has an autosomal-dominant inheritance and is caused by a heterozygous mutation in either the TSC1 or TSC2 gene leading to hyperactivation of the mammalian target of rapamycin (mTOR). TSC is associated with several pulmonary manifestations including lymphangioleiomyomatosis (LAM), multifocal micronodular pneumocyte hyperplasia (MMPH) and chylous effusions. LAM is a multisystem disorder characterised by cystic destruction of lung parenchyma, and may occur in either the setting of TSC (TSC-LAM) or ...
Source: European Respiratory Review - August 3, 2021 Category: Respiratory Medicine Authors: Rebaine, Y., Nasser, M., Girerd, B., Leroux, C., Cottin, V. Tags: Genetics Rare genetic interstitial lung diseases Source Type: research

Liposomal drug delivery to manage nontuberculous mycobacterial pulmonary disease and other chronic lung infections
Nontuberculous mycobacterial (NTM) pulmonary disease is a chronic respiratory infection associated with declining lung function, radiological deterioration and significantly increased morbidity and mortality. Patients often have underlying lung conditions, particularly bronchiectasis and COPD. NTM pulmonary disease is difficult to treat because mycobacteria can evade host defences and antimicrobial therapy through extracellular persistence in biofilms and sequestration into macrophages. Management of NTM pulmonary disease remains challenging and outcomes are often poor, partly due to limited penetration of antibiotics into...
Source: European Respiratory Review - July 20, 2021 Category: Respiratory Medicine Authors: Chalmers, J. D., van Ingen, J., van der Laan, R., Herrmann, J.-L. Tags: Respiratory infections and tuberculosis Review Source Type: research

Update on molecular pathology and role of liquid biopsy in nonsmall cell lung cancer
Personalised medicine, an essential component of modern thoracic oncology, has been evolving continuously ever since the discovery of the epidermal growth factor receptor and its tyrosine kinase inhibitors. Today, screening for driver alterations in patients with advanced lung adenocarcinoma as well as those with squamous cell carcinoma and no/little history of smoking is mandatory. Multiplex molecular platforms are preferred to sequential molecular testing since they are less time- and tissue-consuming. In this review, we present the latest updates on the nine most common actionable driver alterations in nonsmall cell lun...
Source: European Respiratory Review - July 20, 2021 Category: Respiratory Medicine Authors: Abdayem, P., Planchard, D. Tags: Lung cancer Thoracic oncology Source Type: research

Contemporary issues in the implementation of lung cancer screening
Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20–24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation inte...
Source: European Respiratory Review - July 20, 2021 Category: Respiratory Medicine Authors: Lam, S., Tammemagi, M. Tags: Lung cancer Thoracic oncology Source Type: research

Impact of ageing and pregnancy on the minute ventilation/carbon dioxide production response to exercise
Ventilatory efficiency can be evaluated using the relationship between minute ventilation (V'E) and the rate of CO2 production (V'CO2). In accordance with the modified alveolar ventilation equation, this relationship is determined by changes in dead space volume (VD) and/or the arterial CO2 tension (PaCO2) equilibrium point. In this review, we summarise the physiological factors that may account for normative ageing and pregnancy induced increases in V'E/V'CO2 during exercise. Evidence suggests that age-related increases in VD and pregnancy-related decreases in the PaCO2 equilibrium point are mechanistically linked to the ...
Source: European Respiratory Review - July 20, 2021 Category: Respiratory Medicine Authors: Schaeffer, M. R., Guenette, J. A., Jensen, D. Tags: Mechanisms of lung disease Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders Source Type: research

Ventilatory efficiency in pulmonary vascular diseases
Cardiopulmonary exercise testing (CPET) is a frequently used tool in the differential diagnosis of dyspnoea. Ventilatory inefficiency, defined as high minute ventilation (V'E) relative to carbon dioxide output (V'CO2), is a hallmark characteristic of pulmonary vascular diseases, which contributes to exercise intolerance and disability in these patients. The mechanisms of ventilatory inefficiency are multiple and include high physiologic dead space, abnormal chemosensitivity and an altered carbon dioxide (CO2) set-point. A normal V'E/V'CO2 makes a pulmonary vascular disease such as pulmonary arterial hypertension (PAH) or c...
Source: European Respiratory Review - July 20, 2021 Category: Respiratory Medicine Authors: Weatherald, J., Philipenko, B., Montani, D., Laveneziana, P. Tags: Mechanisms of lung disease, Pulmonary vascular disease Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders Source Type: research

Ventilatory efficiency in athletes, asthma and obesity
During submaximal exercise, minute ventilation (V'E) increases in proportion to metabolic rate (i.e. carbon dioxide production (V'CO2)) to maintain arterial blood gas homeostasis. The ratio V'E/V'CO2, commonly termed ventilatory efficiency, is a useful tool to evaluate exercise responses in healthy individuals and patients with chronic disease. Emerging research has shown abnormal ventilatory responses to exercise (either elevated or blunted V'E/V'CO2) in some chronic respiratory and cardiovascular conditions. This review will briefly provide an overview of the physiology of ventilatory efficiency, before describing the ve...
Source: European Respiratory Review - July 20, 2021 Category: Respiratory Medicine Authors: Collins, S. E., Phillips, D. B., Brotto, A. R., Rampuri, Z. H., Stickland, M. K. Tags: Mechanisms of lung disease Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders Source Type: research

Cough symptom severity in patients with refractory or unexplained chronic cough: a systematic survey and conceptual framework
Conclusions Our systematic survey and conceptual framework identified items and domains of cough severity in patients with refractory or unexplained chronic cough. The results support item generation and content validity for a PROM assessing cough severity. (Source: European Respiratory Review)
Source: European Respiratory Review - July 13, 2021 Category: Respiratory Medicine Authors: Kum, E., Guyatt, G. H., Devji, T., Wang, Y., Bakaa, L., Lan, L., Liu, E., Mastrolonardo, A., Couban, R., O'Byrne, P. M., Satia, I. Tags: Respiratory clinical practice Review Source Type: research

Recent developments in the treatment of small cell lung cancer
We describe the progress that has been made in systemic treatment by repurposing existing drugs and the addition of targeted treatment. In recent years, immunotherapy entered the clinic with high expectations of its role in the treatment of SCLC. Unravelling of the genomic sequence revealed new possible targets that may act as biomarkers in future treatment of patients with SCLC. Hopefully, in the near future, we will be able to identify patients who may benefit from targeted therapy or immunotherapy to improve prognoses. (Source: European Respiratory Review)
Source: European Respiratory Review - July 13, 2021 Category: Respiratory Medicine Authors: Hiddinga, B. I., Raskin, J., Janssens, A., Pauwels, P., Van Meerbeeck, J. P. Tags: Lung cancer Review Source Type: research

Measuring pulmonary function in COPD using quantitative chest computed tomography analysis
COPD is diagnosed and evaluated by pulmonary function testing (PFT). Chest computed tomography (CT) primarily serves a descriptive role for diagnosis and severity evaluation. CT densitometry-based emphysema quantification and lobar fissure integrity assessment are most commonly used, mainly for lung volume reduction purposes and scientific efforts. A shift towards a more quantitative role for CT to assess pulmonary function is a logical next step, since more, currently underutilised, information is present in CT images. For instance, lung volumes such as residual volume and total lung capacity can be extracted from CT; the...
Source: European Respiratory Review - July 13, 2021 Category: Respiratory Medicine Authors: Bakker, J. T., Klooster, K., Vliegenthart, R., Slebos, D.-J. Tags: COPD and smoking Review Source Type: research

Management of asthma exacerbations in the paediatric population: a systematic review
Conclusion Comprehensive and updated guidelines compliant with international standards for clinical guidelines may significantly improve clinical practice quality, promote evidence-based recommendations and provide uniformity of treatment between countries. (Source: European Respiratory Review)
Source: European Respiratory Review - July 13, 2021 Category: Respiratory Medicine Authors: Manti, S., Licari, A., Leonardi, S., Marseglia, G. L. Tags: Asthma and allergy Review Source Type: research

Update on recent key publications in lung oncology: picking up speed
Discussion Due to novel therapeutic approaches, numerous new drugs in lung oncology were approved. This has improved symptoms and prognoses in patients with advanced lung cancer. However, faster approval could make it difficult to scrutinise new options regarding safety and efficacy with sufficient diligence. (Source: European Respiratory Review)
Source: European Respiratory Review - July 13, 2021 Category: Respiratory Medicine Authors: Rittmeyer, A., Schiwitza, A., Sahovic, L., Eul, B., Andreas, S. Tags: Lung cancer Thoracic oncology Source Type: research

Epigenetics and sarcoidosis
Epigenetic modifications are emerging as important regulatory mechanisms of gene expression in lung disease, given that they are influenced by environmental exposures and genetic variants, and that they regulate immune and fibrotic processes. In this review, we introduce these concepts with a focus on the study of DNA methylation and histone modifications and discuss how they have been applied to lung disease, and how they can be applied to sarcoidosis. This information has implications for other exposure and immunologically mediated lung diseases, such as chronic beryllium disease, hypersensitivity pneumonitis, and asbest...
Source: European Respiratory Review - June 23, 2021 Category: Respiratory Medicine Authors: Konigsberg, I. R., Maier, L. A., Yang, I. V. Tags: Interstitial and orphan lung disease, Genetics Reviews Source Type: research

Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD
Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are treated with ICSs. We conducted a systematic review including a diversity of types of study designs and safety outcomes with the objective of describing the risk of adverse effects associated with the long-term use of ICSs in patients with COPD. A total of 90 references corresponding to 83 studies were included, including 26 randomised clinical trials (RCTs), 33 cohort studies, and 24 nested case–control (NCC) studies. Analysis of 19 RCTs showed that ...
Source: European Respiratory Review - June 23, 2021 Category: Respiratory Medicine Authors: Miravitlles, M., Auladell-Rispau, A., Monteagudo, M., Vazquez-Niebla, J. C., Mohammed, J., Nunez, A., Urrutia, G. Tags: COPD and smoking Reviews Source Type: research

Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management
Rheumatoid arthritis (RA) is a systemic inflammatory disorder, with the most common extra-articular manifestation of RA being lung involvement. While essentially any of the lung compartments can be affected and manifest as interstitial lung disease (ILD), pleural effusion, cricoarytenoiditis, constrictive or follicular bronchiolitis, bronchiectasis, pulmonary vasculitis, and pulmonary hypertension, RA-ILD is a leading cause of death in patients with RA and is associated with significant morbidity and mortality. In this review, we focus on the common pulmonary manifestations of RA, RA-ILD and airway disease, and discuss evo...
Source: European Respiratory Review - June 23, 2021 Category: Respiratory Medicine Authors: Kadura, S., Raghu, G. Tags: Interstitial and orphan lung disease Reviews Source Type: research

"Design of pulmonary rehabilitation programmes during acute exacerbations of COPD: a systematic review and network meta-analysis." Ana Machado, Pedro Matos Silva, Vera Afreixo, Catia Caneiras, Chris Burtin and Alda Marques. Eur Respir Rev 2020; 29: 200039.
(Source: European Respiratory Review)
Source: European Respiratory Review - June 1, 2021 Category: Respiratory Medicine Tags: Erratum Source Type: research

Antifibrotic drugs in lung transplantation and chronic lung allograft dysfunction: a review
This review aims to provide an overview of pre-transplant antifibrotic therapy on peri-transplant outcomes and to address the possible role of antifibrotics in lung transplant recipients with chronic lung allograft dysfunction. Lung transplantation is an established treatment modality for patients with various end-stage lung diseases, of which idiopathic pulmonary fibrosis and other progressive fibrosing interstitial lung diseases are growing indications. Theoretically, widespread use of antifibrotics prior to lung transplantation may increase the risk of bronchial anastomotic complications and impaired wound healing. Long...
Source: European Respiratory Review - June 1, 2021 Category: Respiratory Medicine Authors: Bos, S., De Sadeleer, L. J., Vanstapel, A., Beeckmans, H., Sacreas, A., Yserbyt, J., Wuyts, W. A., Vos, R. Tags: Interstitial and orphan lung disease Reviews Source Type: research

Unravelling the mechanisms driving multimorbidity in COPD to develop holistic approaches to patient-centred care
COPD is a major cause of morbidity and mortality worldwide. Multimorbidity is common in COPD patients and a key modifiable factor, which requires timely identification and targeted holistic management strategies to improve outcomes and reduce the burden of disease. We discuss the use of integrative approaches, such as cluster analysis and network-based theory, to understand the common and novel pathobiological mechanisms underlying COPD and comorbid disease, which are likely to be key to informing new management strategies. Furthermore, we discuss the current understanding of mechanistic drivers to multimorbidity in COPD, ...
Source: European Respiratory Review - June 1, 2021 Category: Respiratory Medicine Authors: Burke, H., Wilkinson, T. M. A. Tags: COPD and smoking Reviews Source Type: research