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Moving Forward to New Trends in Pulmonary Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: closed (20 March 2026) | Viewed by 25511

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Special Issue Editors

Dr. Ramona Cioboata

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Guest Editor

1. Department of Internal Medicine-Pneumology, University of Medicine and Pharmacy, 200349 Craiova, Romania
2. Pulmonology Department—“Victor Babes” Clinical Hospital of Pulmonology and Infectious Disease, Craiova, Romania
Interests: pulmonary tuberculosis; chronic obstructive airway diseases; bronchiectasis; COVID-19; sleep apnea
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Costin Teodor Streba

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Guest Editor

Department of Internal Medicine-Pneumology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Interests: ultrasound; pulmonary tuberculosis; chronic obstructive airway diseases; interstitial lung disease; lung cancer; pulmonary rehabilitation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to showcase cutting-edge research and emerging trends in the diagnosis, treatment, and management of various pulmonary diseases, including tuberculosis, chronic obstructive pulmonary disease, interstitial lung disease, bronchiectasis, lung cancer, and sleep apnea. Despite recent advances, many challenges persist, such as early detection, drug resistance, and optimizing individualized treatment strategies. Tuberculosis, in particular, remains a global public health priority, with drug-resistant strains posing significant diagnostic and therapeutic hurdles. To address these core problems, we encourage submissions that explore novel diagnostic methods, multidisciplinary therapeutic approaches, and innovative rehabilitation techniques tailored to meet patient-specific needs. This Special Issue aims to mobilize collaborative efforts that foster a deeper understanding of pulmonary pathophysiology, thereby paving the way for improved patient outcomes and more effective, personalized care strategies in respiratory medicine.

Dr. Ramona Cioboata
Prof. Dr. Costin Teodor Streba
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pulmonary tuberculosis
chronic obstructive airway diseases
bronchiectasis
COVID-19
sleep apnea
ultrasound
lung cancer
pulmonary rehabilitation

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Related Special Issue

Moving Forward to New Trends in Pulmonary Diseases: 2nd Edition in Journal of Clinical Medicine

Published Papers (10 papers)

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Research

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11 pages, 656 KB

Open AccessArticle

One-Minute Sit-to-Stand Test Versus Six-Minute-Walk Test in Post-COVID-19 Patients: A Cross-Sectional Observational Study

by Marta Duarte-Silva, Pedro Fiúza, Neuza Reis and Miguel Toscano-Rico

J. Clin. Med. 2026, 15(7), 2479; https://doi.org/10.3390/jcm15072479 - 24 Mar 2026

Viewed by 284

Abstract

Background: Simplified field tests have gained increasing interest for the assessment of functional capacity in patients with post-COVID-19 condition; however, direct comparisons of functional performance and physiological responses between the 1-min sit-to-stand test (1MSTST) and the 6-min walk test (6MWT) remain limited. This study aimed to examine the associations between the two tests by evaluating functional performance, cardiopulmonary responses, oxygen desaturation, perceived exertion, and peripheral muscle strength. Furthermore, we explored whether the 1MSTST can be used as a complementary assessment, particularly within telerehabilitation pathways and in contexts where resource-intensive testing is not feasible. Methods: We conducted a cross-sectional observational study of adults recovering from moderate to severe COVID-19 between May and July 2021. Participants performed both the 1MSTST and 6MWT on the same day. Functional performance, peak heart rate, nadir peripheral oxygen saturation (SpO₂), perceived exertion, and handgrip dynamometry were recorded. Associations between test performances were assessed using correlation and partial correlation analyses, including adjustment for peripheral muscle strength. Results: Fifty-four patients were included. A moderate correlation was observed between 1MSTST repetitions and 6MWT distance (Spearman’s ρ = 0.47, p < 0.001), which was attenuated after adjustment for muscle strength and demographic variables. Peak heart rate and nadir SpO₂ responses were strongly correlated between tests (r = 0.75 and ρ = 0.83, respectively; both p < 0.001), with no significant differences in magnitude. Exercise-induced oxygen desaturation (≥4% SpO₂ drop) occurred at similar frequencies during both tests. Perceived exertion increased similarly following the 1MSTST and the 6MWT. Conclusions: In post-COVID-19 patients, the 1 min sit-to-stand test shows moderate concordance with the 6 min walk test for functional performance and strong agreement in cardiopulmonary responses. These findings suggest that the two tests assess overlapping but distinct aspects of functional capacity. This supports the use of the 1MSTST as a pragmatic complementary assessment when standard walking tests are not feasible, particularly within telerehabilitation pathways, primary care, and resource-limited settings. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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Review

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21 pages, 994 KB

Open AccessReview

Non-Small-Cell Lung Cancer: From Histopathological Classification to Precision Oncology—A Narrative Review

by Simona-Maria Roșu, Viorel Biciușcă, Sorina-Ionelia Stan, Denisa Maria Mitroi, Beatrice Mahler, Diana-Maria Trașcă, Mihaela Popescu, Marian-Marius Pădureanu, Ana-Ștefania Stoica, Tania-Ioana Pencea, Ionela-Alina Croitoru and Mara Amalia Bălteanu

J. Clin. Med. 2026, 15(8), 3042; https://doi.org/10.3390/jcm15083042 - 16 Apr 2026

Viewed by 312

Abstract

Non-Small-Cell Lung Cancer (NSCLC) represents the most prevalent form of lung cancer and remains one of the leading causes of cancer-related morbidity and mortality worldwide. This disease has evolved far beyond traditional histopathological classification. While histology remains foundational, it is no longer sufficient to guide optimal patient management in the era of precision oncology. This review uniquely integrates the full spectrum of NSCLC evaluation, from underlying pathophysiological mechanisms to histological, immunohistochemical, and molecular analyses, culminating in individualized therapeutic planning. We highlight actionable genetic alterations—including EGFR, ALK, ROS1, BRAF, and KRAS—and their roles in guiding targeted therapies, alongside the transformative impact of immune checkpoint inhibitors in selected patients. By emphasizing the interplay between tumor biology, diagnostic workflows, and treatment selection, this review underscores the necessity of comprehensive molecular testing and data integration. Finally, we discuss emerging biomarkers and rational combination strategies that promise to further refine patient stratification and improve outcomes. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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17 pages, 2990 KB

Open AccessReview

Artificial Intelligence in Asthma and COPD: Current Status and Future Potential

by Federica Marrelli, Chiara Lupia, Saverio Nucera, Daniela Pastore, Paolo Zaffino, Carolina Muscoli, Girolamo Pelaia and Corrado Pelaia

J. Clin. Med. 2026, 15(6), 2445; https://doi.org/10.3390/jcm15062445 - 23 Mar 2026

Viewed by 581

Abstract

Interest in artificial intelligence (AI) is rapidly growing. In healthcare, especially through machine learning and deep learning, AI is emerging as a promising tool to support the diagnosis, management, and prevention of lung diseases and to advance personalized care, although it requires large, well-structured datasets. Clinicians must learn how to integrate AI into routine practice for conditions such as asthma and chronic obstructive pulmonary disease (COPD), while ensuring patient safety and building trust in these tools. Chronic respiratory diseases are major global causes of morbidity and mortality and place a substantial burden on healthcare systems; among them, asthma and COPD are chronic disorders characterized by airway obstruction and inflammation. This review highlights the rapid advancement of AI, and it aims to explore the literature’s evidence of its applicability in controlling chronic respiratory disorders, particularly in asthma and COPD. We conducted a narrative literature review by searching ScienceDirect, PubMed, and Google Scholar for English-language studies on artificial intelligence applications in asthma and COPD and by screening the references of relevant articles. The reviewed literature suggests that AI-based approaches are being applied across the asthma–COPD spectrum to support diagnosis and phenotyping, improve risk stratification and prediction of clinically relevant outcomes, and enable more continuous monitoring using heterogeneous data sources (e.g., clinical records, imaging, and digital health data). AI-based tools are poised to support clinicians in asthma and COPD across diagnosis, phenotyping, and monitoring; however, their safe implementation in routine care will require robust validation, transparency, and governance to ensure reliability and patient safety. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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17 pages, 1373 KB

Open AccessReview

Update on the Treatment of Non-Small Cell Lung Carcinoma (NSCLC)

by Yousif A. Kariri

J. Clin. Med. 2025, 14(19), 6960; https://doi.org/10.3390/jcm14196960 - 1 Oct 2025

Cited by 2 | Viewed by 4481

Abstract

Non-small cell lung carcinoma (NSCLC) is a prominent type, with an 85–90% incidence in all lung cancer cases. The evidence for a particular therapy strategy for people with NSCLC is still inadequate. This review evaluates NSCLC therapies that have passed phase IV trials, emphasizing their efficiency and adverse effects. Crucial therapeutic approaches, including dacomitinib, lorlatinib, durvalumab, osimertinib, and rivaroxban, are discussed, highlighting their mechanisms of action, uses, and adverse effects. Immune checkpoint medications are recommended because of their specific activity and minimal adverse reactions. The review also investigates cooperation therapies, such as targeting immune checkpoint inhibitors and hemostasis, alongside chemotherapy, as they offer potential for future therapies. However, further research is needed to improve the safety and efficacy of current treatments, and to explore novel ways to achieve better long-term outcomes. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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12 pages, 633 KB

Open AccessReview

Flexible Bronchoscopy and Non-Small-Cell Lung Cancer Staging: A Narrative Review of Modern Techniques for Optimized Clinical Decision-Making

by Simona-Maria Roșu, Denisa Maria Mitroi, Oana Maria Catană, Viorel Biciușcă, Sorina Ionelia Stan, Beatrice Mahler, Oana-Andreea Parliteanu, Adina Andreea Mirea and Mara Amalia Bălteanu

J. Clin. Med. 2025, 14(16), 5773; https://doi.org/10.3390/jcm14165773 - 15 Aug 2025

Cited by 2 | Viewed by 2533

Abstract

Non-small-cell lung cancer (NSCLC) is a widespread and aggressive form of cancer, and in cases of its occurrence, accurate diagnosis and precise staging play a crucial role in determining treatment and estimating prognosis. Flexible bronchoscopy (FB) is a minimally invasive method used to assess the local and regional extent of the disease. FB facilitates the identification of endobronchial lesions and the collection of biopsy samples for histopathological diagnosis. It also enables the evaluation of regional lymph node involvement via advanced techniques such as endobronchial ultrasound with fine-needle aspiration (EBUS-TBNA). This method has high sensitivity and specificity, reducing the need for more invasive interventions like mediastinoscopy. The integration of endobronchial ultrasound (EBUS) has revolutionized NSCLC staging by providing detailed images and guiding biopsies of suspicious lymph nodes. Additionally, FB is valuable in staging the extent of primary tumor growth, providing critical information about the invasion of adjacent structures. In conclusion, FB, supported by advanced technologies, is important for the staging of NSCLC, improving medical practice and patient prognosis. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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18 pages, 697 KB

Open AccessReview

Chronic Obstructive Pulmonary Disease and COVID-19: The Impact of Hematological Biomarkers on Disease Severity and Outcomes

by Gabriela Mara, Gheorghe Nini and Coralia Cotoraci

J. Clin. Med. 2025, 14(8), 2765; https://doi.org/10.3390/jcm14082765 - 17 Apr 2025

Cited by 3 | Viewed by 2785

Abstract

Background/Objectives: Chronic obstructive pulmonary disease (COPD) patients are at heightened risk of severe COVID-19 due to underlying respiratory impairment, systemic inflammation, and immune dysregulation. This review explores the hematological changes that occur in COPD patients with COVID-19 and their implications for disease progression, prognosis, and clinical management. Methods: We conducted a comprehensive analysis of recent peer-reviewed studies from medical databases including Clarivate Analytics, PubMed, and Google Scholar. Results: Hematological alterations, such as lymphopenia, elevated neutrophil-to-lymphocyte ratio (NLR), increased D-dimer and fibrinogen levels, inflammatory anemia, and erythrocyte dysfunction, are commonly observed in COPD patients with COVID-19. These changes are linked to immune suppression, hyperinflammation, oxidative stress, and thromboembolic complications. Conclusions: Hematological biomarkers are valuable tools for early risk assessments and guiding treatment strategies in this high-risk population. The regular monitoring of D-dimer, fibrinogen, and NLR is advisable. Prophylactic anticoagulation and immunomodulatory therapies, such as corticosteroids and IL-6 and IL-1 inhibitors, may improve clinical outcomes. Further clinical studies are needed to validate personalized approaches and explore antioxidant-based interventions. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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38 pages, 2337 KB

Open AccessReview

Leptin and Insulin in COPD: Unveiling the Metabolic-Inflammatory Axis—A Narrative Review

by Oana Maria Catana, Alexandra Floriana Nemes, Ramona Cioboata, Claudia Lucia Toma, Denisa Maria Mitroi, Cristina Calarasu and Costin Teodor Streba

J. Clin. Med. 2025, 14(8), 2611; https://doi.org/10.3390/jcm14082611 - 10 Apr 2025

Cited by 5 | Viewed by 3627

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating condition characterized by airflow limitations and systemic inflammation. The interaction between the metabolic and inflammatory pathways plays a key role in disease progression, with leptin and insulin emerging as pivotal metabolic regulators. Leptin, an adipokine that regulates energy homeostasis, and insulin, the primary regulator of glucose metabolism, are both altered in COPD patients. This narrative review provides an in-depth examination of the roles of leptin and insulin in COPD pathogenesis, focusing on the molecular mechanisms through which these metabolic regulators interact with inflammatory pathways and how their dysregulation contributes to a spectrum of extrapulmonary manifestations. These disturbances not only exacerbate COPD symptoms but also increase the risk of comorbidities such as metabolic syndrome, diabetes, cardiovascular disease, or muscle wasting. By exploring the underlying mechanisms of leptin and insulin dysregulation in COPD, this review underscores the significance of the metabolic–inflammatory axis, suggesting that restoring metabolic balance through leptin and insulin modulation could offer novel therapeutic strategies for improving clinical outcomes. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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13 pages, 907 KB

Open AccessReview

Central Sleep Apnea in Adults: An Interdisciplinary Approach to Diagnosis and Management—A Narrative Review

by Alpár Csipor Fodor, Dragoș Huțanu, Corina Eugenia Budin, Maria Beatrice Ianoși, Delia Liana Rachiș, Hédi-Katalin Sárközi, Mara Andreea Vultur and Gabriela Jimborean

J. Clin. Med. 2025, 14(7), 2369; https://doi.org/10.3390/jcm14072369 - 29 Mar 2025

Cited by 5 | Viewed by 7491

Abstract

Central sleep apnea (CSA) is a heterogeneous group of sleep-related breathing disorders characterized by intermittent absence of respiratory effort during sleep. CSA results from impaired neurological signaling from the respiratory centers to the respiratory muscles, leading to airflow cessation for at least 10 s. Major causes include heart failure, opioid use, central neurological disorders, and altitude exposure. This review outlines the pathophysiology of CSA, emphasizing ventilatory instability and brainstem dysfunction as key mechanisms. It details the classification of CSA subtypes, including Cheyne–Stokes respiration, high-altitude CSA, and drug-induced CSA. Clinical manifestations range from excessive daytime sleepiness to cardiovascular complications. Diagnostic approaches encompass polygraphy, polysomnography, and various laboratory tests to evaluate comorbidities. Treatment requires a multidisciplinary approach, addressing underlying conditions while utilizing positive airway pressure (PAP) therapy, adaptive servo-ventilation (ASV), supplemental oxygen, and pharmacological interventions. Newer modalities, such as phrenic nerve stimulation, offer promising outcomes for CSA management. This review underscores the necessity of an individualized, interdisciplinary strategy to improve patient outcomes in CSA. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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Other

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21 pages, 1369 KB

Open AccessSystematic Review

Indoor Air Pollution and Lung Cancer Risk—A Systematic Review and Meta-Analysis

by Stefan-Roberto Rusoiu, Norbert Wellmann, Ana Adriana Trusculescu, Andreea Roxana Durdan, Dorotea Carmen Cioanca, Alexandra Bosoanca, Cristian Oancea and Monica Steluta Marc

J. Clin. Med. 2026, 15(5), 1854; https://doi.org/10.3390/jcm15051854 - 28 Feb 2026

Viewed by 789

Abstract

Background/Objectives: Indoor air pollution is an increasingly recognized cause of lung cancer, yet evidence remains fragmented across exposure categories. This systematic review aimed to consolidate epidemiological findings on the relationship between household pollutants and lung cancer risk across diverse settings. Methods: A systematic search of PubMed, Web of Science, Scopus, and Cochrane was conducted to identify observational studies published between 2015 and 2025. Eligible articles evaluated indoor exposure in relation to primary lung cancer. Maximally adjusted effect estimates were extracted. Random effects models were used to calculate pooled odds ratios (ORs) and hazard ratios (HRs) when appropriate. Study quality was assessed using the Newcastle–Ottawa Scale. Results: Thirty-eight studies comprising 475,565 participants were included. Environmental tobacco smoke (ETS) was associated with lung cancer risk (pooled OR 1.97, 95% CI 1.63–2.37; pooled HR 1.44, 95% CI 1.19–1.74). Cooking oil fumes showed a pooled OR of 1.83 (95% CI 1.53–2.21). Solid fuel and biomass combustion were also associated with increased lung cancer risk, with pooled estimates indicating elevated odds and hazard ratios (pooled OR 2.26, 95% CI 1.36–3.77; pooled HR 1.66, 95% CI 1.37–2.02). Incense burning was evaluated in a single study (OR 3.05, 95% CI 1.06–8.84), with wide confidence intervals. Two studies explored gene–environment interactions, suggesting possible variability in susceptibility, although statistical robustness was limited. Conclusions: Across multiple exposure categories, indoor air pollution was consistently associated with lung cancer risk, although the effect magnitude and precision varied between studies. Given the observational nature of the evidence and methodological heterogeneity, further prospective research with standardized exposure assessment is needed to clarify the strength and consistency of these associations. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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10 pages, 812 KB

Open AccessOpinion

Lesson from COVID-19—Adapting Respiratory Rehabilitation Through Early Multidisciplinary Care: An Opinion Paper from Retrospective Data

by Federica Bellone, Adriana Tisano, Giulia Leonardi, Daniela Amato, Daniele Borzelli, Giuseppe Santoro, Angelo Alito, Francesca Cucinotta and Simona Portaro

J. Clin. Med. 2025, 14(11), 3745; https://doi.org/10.3390/jcm14113745 - 27 May 2025

Cited by 1 | Viewed by 1686

Abstract

The COVID-19 pandemic significantly challenged healthcare systems worldwide, highlighting the critical role of early and multidisciplinary rehabilitation interventions. There remains uncertainty about whether these rehabilitation principles developed in response to COVID-19 can be effectively generalized to chronic respiratory diseases. This opinion paper evaluates retrospective data from early stages of the COVID-19 pandemic to propose a comprehensive early multidisciplinary rehabilitation model, potentially applicable across various chronic respiratory conditions. We retrospectively analyzed data from 62 COVID-19 patients hospitalized at the University Hospital of Messina, Italy, between March and June 2020. The patients underwent structured multidisciplinary rehabilitation sessions initiated upon achieving clinical stability. Functional improvements were assessed weekly using the Barthel Index (BI). Significant correlations were observed between initial BI scores and functional improvements at discharge (p < 0.001) and between functional gains and the number of rehabilitation sessions administered (p = 0.025). Early physiatric evaluation significantly enhanced functional recovery (p = 0.036). Early structured multidisciplinary rehabilitation during acute hospitalization demonstrated clear benefits in COVID-19 patients, indicating potential for broad applicability in chronic respiratory disease management. Systematic implementation could improve clinical outcomes, reduce healthcare resource utilization, and enhance patients’ quality of life. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases)

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