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Topic Review
Basis and Progress in Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome (ARDS) is a sudden onset of lung injury characterized by bilateral pulmonary edema, diffuse inflammation, hypoxemia, and a low P/F ratio. Epithelial injury and endothelial injury are notable in the development of ARDS, which is more severe under mechanical stress.
  • 735
  • 26 Jan 2024
Topic Review
Outdoor Air Pollution and Childhood Respiratory Disease
The leading mechanisms through which air pollutants exert their damaging effects are the promotion of oxidative stress, the induction of an inflammatory response, and the deregulation of the immune system by reducing its ability to limit infectious agents’ spreading. This influence starts in the prenatal age and continues during childhood, the most susceptible period of life, due to a lower efficiency of oxidative damage detoxification, a higher metabolic and breathing rate, and enhanced oxygen consumption per unit of body mass. Air pollution is involved in acute disorders like asthma exacerbations and upper and lower respiratory infections, including bronchiolitis, tuberculosis, and pneumoniae. Pollutants can also contribute to the onset of chronic asthma, and they can lead to a deficit in lung function and growth, long-term respiratory damage, and eventually chronic respiratory illness. Air pollution abatement policies, are contributing to mitigating air quality issues, but more efforts should be encouraged to improve acute childhood respiratory disease with possible positive long-term effects on lung function. 
  • 727
  • 07 Jul 2023
Topic Review
Clinical Trials of Monoclonal Antibodies for Asthma
Monoclonal antibodies have been developed for the treatment of severe asthma, with numerous randomised controlled trials (RCTs) conducted to define their safety and efficacy. The growing availability of biologics, which have only been available for T2-high asthma, has been further enriched by the arrival of tezepelumab. All biologic agents are effective in improving asthma control, especially with regard to reducing exacerbation rates and oral corticosteroid (OCS) use. Biologics are all effective, albeit with important differences. What fundamentally guides the choice is the patient’s clinical history, the endotype represented by biomarkers (especially blood eosinophils), and comorbidities (especially nasal polyposis).
  • 717
  • 03 Mar 2023
Topic Review
Role of Infection in Cystic Fibrosis Lung Disease
Cystic fibrosis (CF) is an autosomal genetic multisystemic disease. The basic defect lies in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein caused by mutations in the respective gene. Infection play an important role in the pathophysiology of cystic fibrosis, and it is one of the significant causes of morbidity and mortality in CF.
  • 708
  • 27 Dec 2022
Topic Review
Management of Malignant Pleural Effusions
Overview of current guidelines and practices in the management of malignant pleural effusion
  • 704
  • 02 Dec 2021
Topic Review
Local Anaesthetic Thoracoscopy
The incidence of pleural disease is increasing, and interventions are crucial in this subspecialist area of respiratory medicine. One of the cornerstones of pleural effusion investigation and management is medical, which is also known as local anaesthetic thoracoscopy.
  • 697
  • 01 Nov 2022
Topic Review
Vascular Permeability in Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis (IPF) is a disease that causes scarring and fibrotic transformation of the lung parenchyma, resulting in the progressive loss of respiratory function and, often, death. An increasing body of literature shows that pulmonary vascular permeability may play a big role in the pathogenesis of this condition. There is a search for therapeutic targets to try and modulate this vascular permeability in fibrotic lungs. One such class of targets that shows great promise is sphingolipids.
  • 695
  • 02 Aug 2023
Topic Review
Obstructive Sleep Apnea and Inflammation
Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates.
  • 688
  • 21 Jan 2022
Topic Review
Mechanisms in Development of Idiopathic Pulmonary Fibrosis
Fibroblasts synthesize collagen, fibronectin, and extracellular matrix (ECM). Myofibroblasts—other cells involved in fibrosis—secrete factors such as VEGF and TGF-β, produce denser but more disorganized ECM than fibroblasts, and persist longer at the injury site. One cytokine involved in tissue repair is TGF-β. Sources of TGF-β include platelet granules and macrophages. TGF-β is predominantly expressed in PF and helps stimulate the formation of ECM, collagen, fibronectin, elastic fibers, and matrix substances.
  • 684
  • 04 Feb 2024
Topic Review
Effect of Long-Acting Muscarinic Antagonists on Asthma
Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). 
  • 675
  • 25 Jul 2023
Topic Review
Extracellular Vesicles and Lung Diseases
Although cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) stem from a different origin, one genetic and the other acquired, they share a similar pathophysiology, being the CF transmembrane conductance regulator (CFTR) protein implied in both disorders. Various subsets of EVs, comprised mainly of microvesicles (MVs) and exosomes (EXOs), are secreted by various cell types that are either resident or attracted in the airways during the onset and progression of CF and COPD lung disease, representing a vehicle for metabolites, proteins and RNAs (especially microRNAs), that in turn lead to events as such neutrophil influx, the overwhelming of proteases (elastase, metalloproteases), oxidative stress, myofibroblast activation and collagen deposition.
  • 674
  • 05 Jan 2023
Topic Review
Matching the Inhaler to the Patient in COPD
Selecting the most appropriate inhalation device from the wide range available is essential for the successful management of patients with chronic obstructive pulmonary disease. Although choice is good for healthcare professionals, knowing which inhaler to prescribe is a complex consideration. Among the key factors to consider are quality of disease control, inhaler technique, inhaler resistance and inspiratory flow, inhaler design and mechanisms of drug delivery, insurance and reimbursement restrictions, and environmental impact. In this entry, we offer a simple, practical tool that brings together all these factors and includes hyperlinks to other published resources from the United Kingdom, Belgium, and The Netherlands.
  • 671
  • 10 Dec 2021
Topic Review
Key Elements in Diagnosing Pulmonary Sarcoidosis
Sarcoidosis is a complex multisystemic granulomatous disease, with unknown etiology and variable clinical manifestations, which frequently manifests with thoracic (bilateral hilar lymphadenopathies and pulmonary infiltrates), ocular, and cutaneous involvement. The diagnosis of sarcoidosis requires the identification of noncaseated epithelioid granulomas in one or more organs along with the exclusion of other pathologies that could cause granulomatous lesions. 
  • 669
  • 18 Jan 2023
Topic Review
Forced Oscillation for Monitoring Children with Cystic Fibrosis
Cystic fibrosis (CF) is a multi-system genetic disease with a considerable burden of morbidity that is mainly attributed to respiratory health deterioration. Forced oscillation technique (FOT) requires minimal cooperation from the patient as it is effort-independent. All it needs is resting tidal breathing through a mouthpiece while sound waves of different frequencies are superimposed through a loudspeaker. It has been used mainly for monitoring patients with asthma but is increasingly being applied in patients with CF.
  • 667
  • 26 Oct 2021
Topic Review
Role of Food in QoL of COPD Patients
The diet has been described as a modifiable risk factor for the development and progression of chronic diseases, and emerging evidence increasingly highlights its preventive and therapeutic role in chronic obstructive pulmonary disease (COPD). While the association between underlying conditions such as metabolic disorders, obesity, diabetes, etc., and diet is natural, the direct impact is not as obvious in chronic obstructive pulmonary disease. The quality of poor nutrition and the development of nutrient deficiencies in respiratory diseases, including COPD, can be correlated with disease-specific factors such as worsening respiratory symptoms. These symptoms can be improved through dietary interventions, leading to positive changes in the pathogenesis of the disease and the quality of life for patients.
  • 662
  • 02 Jan 2024
Topic Review
Antifungals for Host-Directed Antiviral Therapy
Because of their epidemic and pandemic potential, emerging viruses are a major threat to global healthcare systems. While vaccination is in general a straightforward approach to prevent viral infections, immunization can also cause escape mutants that hide from immune cell and antibody detection. Thus, other approaches than immunization are critical for the management and control of viral infections. Viruses are prone to mutations leading to the rapid emergence of resistant strains upon treatment with direct antivirals. In contrast to the direct interference with pathogen components, host-directed therapies aim to target host factors that are essential for the pathogenic replication cycle or to improve the host defense mechanisms, thus circumventing resistance. These relatively new approaches are often based on the repurposing of drugs which are already licensed for the treatment of other unrelated diseases. 
  • 659
  • 01 Mar 2022
Topic Review
The Exposome Approach in Allergies and Lung Diseases
Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept.
  • 658
  • 17 Dec 2021
Topic Review
Mucins and Cystic Fibrosis Transmembrane Conductance Regulator
Mucociliary clearance is a critical defense mechanism for the lungs governed by regionally coordinated epithelial cellular activities, including mucin secretion, cilia beating, and transepithelial ion transport. Cystic fibrosis (CF), an autosomal genetic disorder caused by the dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) channel, is characterized by failed mucociliary clearance due to abnormal mucus biophysical properties. 
  • 644
  • 16 Sep 2022
Topic Review
Efficacy of Elexacaftor-Tezacaftor-Ivacaftor in Cystic Fibrosis Treatment
Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) is a new CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) modulator treatment, which has shown an improvement in different clinical outcomes in patients with cystic fibrosis (CF). ELX/TEZ/IVA has a significant positive effect on the lung function of patients with CF, by ameliorating parameters such as FEV1, LCI, pulmonary exacerbations or sweat chloride concentration, increasing BMI and improving quality of their life. Its role in cystic fibrosis-related diabetes (CFRD) is not yet clear. It was found that this new CFTR modulator has an overall favorable safety profile, with mild to moderate adverse events. 
  • 635
  • 26 Apr 2023
Topic Review
Transbronchial Techniques for Lung Cancer Treatment
The demand for parenchyma-sparing local therapies for lung cancer is rising owing to an increasing incidence of multifocal lung cancers and patients who are unfit for surgery. With the latest evidence of the efficacy of lung cancer screening, more premalignant or early-stage lung cancers are being discovered and the paradigm has shifted from treatment to prevention. Transbronchial therapy is an important armamentarium in the local treatment of lung cancers, with microwave ablation being the most promising based on early to midterm results. Adjuncts to improve transbronchial ablation efficiency and accuracy include mobile C-arm platforms, software to correct for the CT-to-body divergence, metal-containing nanoparticles, and robotic bronchoscopy.
  • 634
  • 23 Feb 2023
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