BACKGROUND:Environmental (E) and occupational (O) lung cancer (LC) is under-reported. Raising the awareness for this problem could help optimize prevention and screening. METHODS:In 181 consecutive non-small cell LC patients (January 2023-December 2024, University Hospital of Liège, Belgium) E risk factors (RF) and ORF were collected through a self-reporting questionnaire (open and direct questions) with sociodemographic, tumor- and work-related data. The primary objective was to identify ERF and ORF prevalence. RESULTS:Mean age was 68.2 ± 8.8 years, 55.8% males, 93.4% (former) smokers. Half of the patients (53%) lived in (peri-)urban areas. 50% disclosed an obstructive airway disease and 31.5% had a positive LC family history. Of the 270 jobs registered, 78.5% were manual. Only 23.8% of the workers used protective equipment. 72.4% of the patients reported exposure to at least one ORF through direct questions, and the most frequent pulmonary carcinogens were asbestos (36.5%), silica (22.1%), welding fumes (15.5%), polycyclic aromatic hydrocarbons (14.9%), and diesel engine exhaust (14.4%). Overall, 93.9% of patients reported at least one E/ORF other than tobacco. A request for compensation was introduced in <3% of the patients. CONCLUSION:Non-tobacco RF for LC are virtually always present in non-small cell LC patients and under-reported. TRIAL REGISTRATION:ClinicalTrials.gov (NCT00005602,259).
INTRODUCTION:Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection (LRTI) in young children. In children < 5 years old, it causes an estimated 33 million LRTI episodes and over 100,000 deaths annually, two-thirds of which occur in infants. The licensure of new long-acting monoclonal antibodies and a maternal RSV vaccine offer opportunities for reducing RSV related infant morbidity and mortality. AREAS COVERED:This drug profile reviews clesrovimab (Enflonsia, Merck & Co. Inc. Rahway, NJ U.S.A.), an extended half-life human IgG1κ monoclonal antibody, targeting the highly conserved antigenic site IV of the RSV fusion protein. We synthesize evidence from phase 1 to phase 3 clinical trials, pharmacokinetic and pharmacodynamic data, regulatory approvals and resistance profiling, drawing on peer-reviewed literature and regulatory sources available until May 2026. EXPERT OPINION:Clesrovimab offers a single, fixed-dose, weight-independent injection per RSV season, with demonstrated safety and efficacy against medically attended RSV disease and hospitalization in infants. Its epitope target is distinct from that of nirsevimab (site Ø) and no cross resistance between the two antibodies has been observed in vitro. Equitable global access to monoclonal antibodies, particularly for low- and middle-income countries, remains critical to reduce the global RSV burden.
INTRODUCTION:Acute chest syndrome (ACS) is a common sickle cell disease (SCD) complication. Infectious pathogens are the most common causes of ACS followed by pulmonary infarction and fat embolism. Infectious pathogens responsible for ACS include viruses, atypical bacteria (Mycoplasma pneumoniae and Chlamydia pneumoniae), and bacteria. AREAS COVERED:The introduction of conjugate pneumococcal and Hemophilus influenzae b vaccines and implementation of penicillin prophylaxis has significantly reduced, but not eliminated the risk of bacterial infections in this population. However, pneumococcal infections still occur but may further decline with the introduction of expanded conjugate vaccines such as PCV20. The introduction of multiplexed PCR respiratory panels in 2014 has enabled more accurate diagnosis of the infectious pathogens responsible for ACS in children with SCD. Recent studies using these panels have found that the majority of cases of ACS were associated with viral infections. M. pneumoniae and C. pneumoniae infections were uncommon. EXPERT OPINION:We suggest that empiric antibiotics in children with SCD presenting with ACS be limited to ceftriaxone. Azithromycin should only be used if the respiratory pathogen panel is positive for M. pneumoniae or C. pneumoniae, as azithromycin will remain in the system for over 7-days even if discontinued after one dose.
INTRODUCTION:The occurrence of severe storms and floods has steadily increased over the last decades world-wide because of climate change and global warming. Flooding events have important effects on respiratory health especially in vulnerable populations. Some health effects are immediate, such as respiratory infections, asthma attacks and chronic obstructive pulmonary disease exacerbations. An important immediate risk arises for patients with technology dependent respiratory conditions if power supplies fail. Post-flood, indoor damp and mold develop in flooded homes creating a high risk of developing chronic respiratory disease in residents. AREAS COVERED:This review summarizes what is known about the immediate and the medium- to long-term effects of flooding on respiratory health. The negative health effects of prolonged living in a damp and moldy home are discussed. EXPERT OPINION:Climate change and global warming appear to be progressing at a more rapid pace than previously predicted and this will increase the number and the severity of global storm and flood events. Floods pose a substantial risk to patients with chronic respiratory disease and health systems world-wide need to be more aware and prepare to manage the immediate and the long-term needs of increasing numbers of patients affected by natural disasters.
INTRODUCTION:Despite significant advances in precision medicine, managing severe asthma remains a major clinical challenge. Small airway dysfunction (SAD) is a crucial determinant of poor symptom control, airway remodeling, and frequent exacerbations. While conventional spirometry primarily assesses large airway mechanics, airway oscillometry (AO) provides a highly sensitive, effort-independent evaluation of peripheral resistance and reactance during normal breathing. AREAS COVERED:This review synthesizes current evidence from major biomedical databases (PubMed, Embase, Scopus, and Web of Science; 2000-2026) regarding the physiological role of SAD across severe asthma phenotypes (eosinophilic vs. non-eosinophilic). Furthermore, it systematically evaluates the specific impact of targeted biological therapies (anti-IgE, anti-IL-5/IL-5 R, anti-IL-4/13 Rα, and anti-TSLP) on distal respiratory mechanics. EXPERT OPINION:SAD represents a vital treatable trait in severe asthma. Biologics exert distinct physiological effects on peripheral parameters, with upstream modulators such as dupilumab and tezepelumab demonstrating superior efficacy in reversing distal mucus plugging and frequency-dependent resistance abnormalities. Incorporating AO into routine clinical algorithms alongside T2 inflammatory biomarkers is essential to refine endophenotyping, improve overall risk stratification, guide personalized biologic selection, and accurately monitor functional therapeutic responses in patients with severe refractory asthma.
INTRODUCTION:Disinformation refers to false information deliberately shared with the intent to cause harm. Disinformation is escalating because health is a global concern and tends to elicit strong emotional responses. Misinformation refers to false information shared without malicious intent. AREAS COVERED:Health-related misinformation and disinformation undermine prevention efforts, distort health behaviors, and erode trust in institutions and professionals. A French mission identified three vulnerabilities: low health literacy, difficulty in assessing the reliability of sources, and algorithm-driven exposure to information. Current responses remain fragmented, scientists are frequently targeted, and those spreading disinformation are rarely sanctioned. The strategy we propose rests on six pillars (education, training, improved information systems, detection, sanctions, and strengthened research) coupled with coordinated action at national and European levels. Respiratory health stands at the crossroads of several highly contested domains: tobacco and nicotine products, air pollution, chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease, and respiratory infections, including COVID-19, influenza, and respiratory syncytial virus infections. EXPERT OPINION:Respiratory societies have called for defending independent science, countering online disinformation, and strengthening international collaboration. Learned societies, regulators and EU institutions must align their efforts across research, policy, and the oversight of social media platforms.
BACKGROUND AND OBJECTIVE:Patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) are at increased risk of sepsis, yet the comparative infection-related outcomes of newer antihyperglycemic agents remain unclear. We evaluated the associations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus sodium-glucose cotransporter-2 inhibitors (SGLT2is) with infection outcomes in this population. METHODS:In this retrospective cohort study using the TriNetX global federated database, individuals aged 40-100 years with coexisting COPD and T2DM who initiated a GLP-1RA or SGLT2i between 2021 and 2024 were identified. A new-user, active-comparator design with 1:1 propensity score matching was applied. Sepsis was the primary outcome; all-cause mortality and components of the primary outcome were secondary. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS:After matching, 45,491 pairs were included. Compared with SGLT2is, GLP-1RAs showed lower risks of sepsis (adjusted HR, 0.832; 95% CI, 0.781-0.887), all-cause mortality (0.642; 0.598-0.689), and severe sepsis (0.841; 0.774-0.914). CONCLUSION:In patients with COPD and T2DM, GLP-1RAs were associated with significantly lower risks of sepsis and all-cause mortality compared with SGLT2is.
INTRODUCTION:Urban air pollution is a critical environmental determinant of pediatric respiratory health. This PRISMA 2020-guided systematic review synthesizes evidence on the association between short-term exposure to urban ambient air pollutants and asthma-related morbidity in children under five years of age. METHODS:PubMed and Google Scholar were searched for urban time-series or case-crossover studies published between 2021 and 2025 (final search: 15 January 2026). Eligible outcomes included hospital admissions, emergency department visits, or urgent consultations in children aged 0-5 years. Two reviewers independently screened records, extracted data, and assessed study quality. Due to methodological heterogeneity, a structured narrative synthesis was performed. RESULTS:Four studies met the inclusion criteria. Across settings, short-term increases in particulate matter (PM_{2.5}/PM_{10}) and nitrogen dioxide (NO_2) were consistently associated with increased asthma-related hospitalizations or urgent visits. Stronger effects were reported during cold seasons and in high-traffic environments. CONCLUSIONS:Short-term exposure to traffic-related and particulate pollutants exacerbates asthma morbidity in vulnerable preschool children. However, the certainty of evidence was rated as low due to residual confounding, potential exposure misclassification inherent to observational designs, and the limited number of eligible studies. These findings support strengthening urban air-quality policies. PROTOCOL REGISTRATION:PROSPERO (Identifier: CRD420251251275; Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251251275.
INTRODUCTION:With advances in neonatal care over the last three decades leading to improved survival from preterm birth, it is becoming increasingly evident that preterm-born individuals experience respiratory morbidity and reduced lung function through the life course, now termed prematurity-associated lung disease (PLD), with increasing concern regarding the onset of chronic obstructive pulmonary disease in early adult life. AREAS COVERED:In this article, we will cover the current evidence for screening, monitoring, and management of PLD. We shall discuss monitoring strategies utilizing lung function testing, lung imaging, and oximetry, among others. Although current data regarding optimal management and treatment are limited, we shall discuss pharmacological and non-pharmacological methods currently for PLD. EXPERT OPINION:It is now clear that long-term respiratory follow-up for high-risk preterm-born individuals is imperative to identify PLD early, monitor its progress, and optimize respiratory outcomes. There must be increased recognition from pediatric and adult physicians of the impact of prematurity and low birth weight on respiratory health in later life, with services developed to transition individuals with PLD from pediatric to adult care. Future research should aim to improve understanding of PLD phenotypes and phenotype-targeted interventions to optimize respiratory health in PLD across the life course.
INTRODUCTION:Pulmonary hypertension (PH) remains a progressive and life-threatening disease despite advances in therapies targeting multiple signaling pathways. Prostacyclin analogues play a central role in treatment; however, systemic formulations can be limited by treatment burden and systemic adverse effects. Inhaled treprostinil has emerged as an important prostacyclin-pathway therapy that allows targeted pulmonary artery vasodilation while minimizing systemic exposure, with relevance for pulmonary arterial hypertension (PAH) and PH associated with interstitial lung disease (PH-ILD). AREAS COVERED:This review provides a comprehensive overview of the pharmacology, pharmacokinetics, and clinical development of inhaled treprostinil across both currently available and investigational formulations. All major clinical trials are examined, including pivotal early Phase I-II investigations. We discuss all commercially available and emerging delivery platforms including nebulized, dry-powder, liposomal, and prodrug formulations. In addition, the review addresses safety, real-world utilization, regulatory status, and the evolving therapeutic and commercial landscape of inhaled prostacyclin therapy. EXPERT OPINION:Inhaled treprostinil has become a key treatment option in PH-ILD and PAH management. Continued development of longer-acting formulations and improved delivery systems may enhance adherence and expand its clinical role. Emerging evidence suggesting potential antifibrotic effects raises the possibility that inhaled treprostinil could influence disease progression in pulmonary fibrosis, potentially broadening its therapeutic applications in the coming years.
INTRODUCTION:Patients with eosinophilic asthma are at increased risk of poor asthma control despite optimized standard therapy. Depemokimab, a novel long-acting anti-interleukin-5 monoclonal antibody, has shown efficacy in reducing exacerbations; however, its effects across clinical outcomes have not been comprehensively synthesized. METHODS:PubMed, Embase, Cochrane databases, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing depemokimab with placebo. Outcomes included Asthma Control Questionnaire-5 (ACQ-5), asthma exacerbation rate, quality of life assessed by St. George's Respiratory Questionnaire (SGRQ), and adverse events. Results were reported as mean differences (MDs) or incidence rate ratios (IRRs) with 95% confidence intervals (CIs), and heterogeneity was assessed using the I2 statistic. RESULTS:Four RCTs (n = 954) were included. Depemokimab did not significantly improve ACQ-5 (MD -0.30; 95% CI -0.92 to 0.32; I2 = 73.6%; p = 0.23), but reduced exacerbation rates (IRR 0.47; 95% CI 0.36 to 0.59; I2 = 0%; p < 0.001) and modestly improved SGRQ scores without reaching the MCID (MD -2.80; 95% CI -5.38 to -0.23; I2 = 0.0%; p = 0.033). Safety was comparable to placebo. CONCLUSIONS:Depemokimab reduced exacerbations and had a comparable safety profile, but did not improve symptom control or achieve the MCID for health-related quality-of-life. REGISTRATION:The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420261282685).
BACKGROUND:MicroRNAs (miRNAs) have been proposed as diagnostic biomarkers of asbestos-related cancers, but their role in asbestos-related interstitial lung diseases (ILDs) is unknown. RESEARCH DESIGN AND METHODS:We conducted a pilot study in 30 subjects: 11 unexposed population controls, 8 ILD-free asbestos-exposed subjects, and 11 asbestos-related ILD cases. We used the Receiver Operator Characteristic (ROC) Area Under the Curve (AUC) to estimate the diagnostic accuracy of miRNAs, and volcano plots to assess their differential expression between the study groups. RESULTS:miR-548h-5p was over-expressed in ILD-free asbestos-exposed subjects and demonstrated a 90% accuracy (95% CI: 0.75-1.00) in discriminating them from unexposed subjects, as well as a 96% diagnostic accuracy (95% CI: 0.88-1.00) in differentiating asbestos-related ILD cases from ILD-free asbestos-exposed subjects. miR-6127-3p was over-expressed and showed an accuracy of 85% (95% CI: 0.66-1.00) in discriminating asbestos-related ILD cases from unexposed subjects in plasma. let-7f-5p was over-expressed in the exhaled breath condensate (EBC) of ILD-free asbestos-exposed subjects and showed a 90% accuracy (95% CI: 0.76-1.00) in discriminating them from unexposed subjects. CONCLUSIONS:Our results suggest that the plasma and EBC miRNA profile might serve as a diagnostic biomarker of asbestos-related ILDs.
BACKGROUND:Bovhyaluronidase azoximer (BA) has been reported to improve pulmonary function and exercise tolerance in patients with pulmonary sequelae of COVID-19. In this multicenter, randomized, double-blind, placebo-controlled study, we evaluated the effects of BA on patients with long-term (up to 12 months) pulmonary sequelae of COVID-19. METHODS:Patients (n = 392) were randomized 1:1 to receive BA or placebo every 5 days for 71 days. Percent predicted forced vital capacity (ppFVC), respiratory symptoms, and exercise tolerance indicators were assessed at baseline and on Days 71 (Δ ppFVC was the primary endpoint) and 180. RESULTS:The pre-specified primary endpoint (Δ ppFVC at Day 71) was negative (+0.30%, p = 0.817). Secondary endpoints showed reduced exertional desaturation (OR 0.36, p = 0.006) and dyspnea (OR 0.62, p = 0.040). CONCLUSION:While the primary objective yielded clinically insignificant results, patients treated with BA showed increased exercise tolerance although further investigations are required to confirm findings. TRIAL REGISTRATION:The study is registered at ClinicalTrials.gov (NCT06383819).
BACKGROUND:Idiopathic inflammatory myopathies (IIMs) are frequently complicated by interstitial lung disease (ILD). The independent clinical significance of myositis autoantibody positivity remains incompletely defined. METHODS:We performed a retrospective cohort study of patients undergoing myositis autoantibody testing at a single tertiary center (1997-2022). Multivariable logistic regression assessed the association between antibody positivity and ILD. Subgroup analyses evaluated clinical phenotypes and radiologic patterns. RESULTS:Among 1,034 patients included in the analysis, 359 (34.7%) were positive for at least one myositis autoantibody and 365 (35.5%) had ILD. Antibody-positive patients were younger, more frequently female, and had a higher prevalence of ILD compared to antibody-negative patients (41.2% vs. 32.2%, p < 0.01). Myositis autoantibody positivity was independently associated with ILD (adjusted OR 1.78, 95% CI 1.33-2.37, p < 0.001). Increasing age, higher BMI, former smoking status, and Asian ethnicity were also associated with ILD. Among patients with ILD, antibody-positive individuals had a higher prevalence of systemic autoimmune features, including Raynaud's phenomenon, arthritis, and mechanic's hands, as well as higher inflammatory markers and more impaired pulmonary function. CONCLUSION:Myositis autoantibody positivity is independently associated with ILD and identifies a distinct clinical phenotype. These findings should be interpreted in the context of the study's retrospective, single-center design.
Introduction: Management of pediatric laryngotracheal stenosis remains a complex and multidisciplinary process, with implications of surgery that extend far beyond the operating room. Ideal care for pediatric patients undergoing complex airway reconstruction requires a holistic approach that includes attention to patient and caregiver needs, quality of life measures, and the optimization of secondary outcomes of surgery, such as voicing and swallowing. Areas covered: This special report highlights the impact of non-surgical and secondary outcomes of complex airway reconstruction in pediatric patients with laryngotracheal stenosis. Articles queried from PubMed are reviewed in this report, with special attention to literature that focuses on quality-of-life metrics after pediatric airway reconstruction and that which examines post-operative dysphonia and dysphagia in this population. Additional insight and data from a high-volume pediatric airway reconstructive center are included in this discussion. Expert opinion: Comprehensive care of a pediatric patient with laryngotracheal stenosis extends beyond surgery and involves multidisciplinary management of long-term sequelae to truly improve the quality of life of patients and their caregivers.
IntroductionWhile the standard HRZE regimen is the cornerstone of drug-susceptible tuberculosis (DS-TB) treatment, its success is frequently undermined by treatment-limiting adverse drug reactions (ADRs) and complex drug-drug interactions (DDIs). In clinical practice, managing those situations remains a critical challenge often overlooked by guidelines. Effective toxicity management is essential to prevent treatment interruption, loss-to-follow up, relapse, and escalating healthcare costs.Areas coveredWe provided a clinical framework for identifying and mitigating toxicities associated with HRZE regimen. Reviewing current literature and international guidelines, we analyzed different ADRs, provided safety profiles and management strategies for each HRZE drug. The discussion includes structured protocols for sequential drug re-challenge, management of high-risk populations, and DDIs. Furthermore, we evaluate evidence-based alternative regimens for cases where the standard of care is untenable.Expert opinionDS-TB therapy must evolve from rigid protocols toward a precision medicine framework prioritizing patient safety alongside efficacy. We advocate for a 'shorter is better, less is more' approach, emphasizing regimen simplification and better-tolerated agents. Clinical success often depends on proactive communication between clinicians and patients, as well as individualized therapeutic adjustments, rather than on novel compounds alone. Bridging the gap between standardized guidelines and nuanced clinical judgment is vital for optimizing real-world outcomes.
INTRODUCTION:Clinical outcomes with cystic fibrosis (CF) vary substantially even among individuals with the same cystic fibrosis transmembrane conductance regulator (CFTR) genotype due to the wide spectrum of exposures that are linked to the social determinants of health. AREAS COVERED:The exposome framework offers a comprehensive lens to understand the non-genetic contributors to CF variability and the mechanisms by which sociodemographic characteristics impact upon health. It provides a structured approach to studying the effects of the natural, built, social, and policy environments on CF outcomes, as well as their internal biological effects. EXPERT OPINION:Integrating exposome science with multi-omics and clinical data promises to advance precision medicine, improve risk prediction, and reduce health disparities in CF. Addressing the challenges of exposome research will require multidisciplinary collaboration, innovative methodologies, and a commitment to translating findings into equitable clinical care.
BACKGROUND:Respiratory oscillometry provides effort-independent indices of airway heterogeneity (R5-20) and respiratory system stiffness (AX). Their clinical relevance in interstitial lung diseases (ILD) remains unclear and was the aim of our study. RESEARCH DESIGN AND METHODS:A cross-sectional study including patients with ILD who underwent oscillometry, pulmonary function tests (PFTs), and six-minute walking distance (6MWD) at a single visit. R5-20 and AX were analyzed as continuous variables and as thresholds derived from receiver operating characteristic (ROC) analysis for progressive pulmonary fibrosis (PPF). Associations with clinical outcomes were assessed using multivariable regression models. RESULTS:Ninety-four patients (median age 70y; 44% females) were included. Oscillometry parameters correlated with PFTs and 6MWD, and had a moderate discriminative ability for PPF (AUC 0.747-0.764). Abnormal oscillometry was identified in 46 patients (49%) and was not associated with any baseline characteristic or ILD subtype. However, it was linked to lower DLCO (48% vs. 54% predicted, p = 0.02) and reduced 6MWD (median [IQR] 413 [354-503] vs. 465 [425-533] meters, p = 0.024). R5-20 was higher in patients with air-trapping or mosaic attenuation in chest CT, although not in those with honeycombing or traction bronchiectasis. CONCLUSION:Oscillometric abnormalities are common in ILD and independently associated with disease severity.
INTRODUCTION:chronic respiratory infections represent a significant source of global morbidity and mortality, especially among individuals with structural lung diseases or compromised defenses. Emerging evidence highlights the role of environmental factors, such as climate change, air pollution, and urbanization, in the epidemiology and progression of these infections. AREAS COVERED:This review synthesizes current research on the interactions between climate conditions, pollution, and urbanization in bronchiectasis, cystic fibrosis, nontuberculous mycobacterial (NTM) pulmonary disease, and chronic pulmonary aspergillosis. A search of relevant medical literature in the English language was conducted in Medline/PubMed, EMBASE and Scopus up to January 2026.Increases in temperature, fluctuations in humidity, extreme weather events (e.g. heatwaves, floods, and cold spells), and elevated concentrations of particulate matter contribute to both pathogen proliferation and increased host susceptibility, which impact the severity and incidence of chronic respiratory infections, particularly those caused by environmental pathogens such as non-tuberculous mycobacteria and Aspergillus spp. respiratory infections. Higher urban density and changes in microbial ecosystems further enhance transmission and chronicity. EXPERT OPINION:Understanding the complex interactions between environmental stressors and respiratory health and incorporating environmental risk assessment into clinical practice and public health policy is crucial for reducing disease burden in the context of accelerating climate change.
